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Jwara Chikitsa (view source)

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jwaradhikAre yadvAcyaM tat saumya! nikhilaM shRuNu||10||

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Punarvasu, who was free from all types of diseases (''jwara'') and was having complete peace of mind, was sitting in a lonely place; where Agnivesha approached him and asked his queries about ''jwara'' with a modest ''namaskar'' (greeting, with hands folded).

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*The therapies which should be administered in order to alleviate this reattack of this fever;

After hearing this statement of Agnivesha, the preceptor (Atreya) replied: “all these will be explained in this chapter on the description of fever. Oh benevolent one, listen to the details.”[3-10]

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=== Synonyms of ''jwara'' ===

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ityasya prakRutiH proktA, ...|14|

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The three physical ''doshas'' and the two ''manasika doshas'' are the natural factors responsible for ''jwara'' (''prakriti'') as ''jwara'' cannot originate in a person having the balance of these three ''dosha'' (''nirdosha'' – in the state of homeostasis). Therefore, these ''sharirika'' and ''manasika doshas'' are the prakriti of ''jwara''.

''Kshaya'' (emaciation), ''tama'' (feeling of entering into darkness), ''jwara, papma'' (manifestations of the sinful acts) and ''mrityu'' (death) are all the various presentations of Yamaraja (lord of deaths). These are the causes of death (''panchatva'') in individuals suffering from various grievances, due to their own deeds and hence have been accepted as equivalent to Yama (lord of death). In this way the ''prakriti'' (basic nature) of ''jwara'' has been described. [12-13]

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=== ''Pravritti'' (origin of the disease) ===

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janmAdau nidhane ca tvamapacArAntareShu ca||25||

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The origin of ''jwara'' is because of the tendency for greed or attachment (''parigraha''). It has been described earlier in the [[Nidana Sthana]] that the origin of ''jwara'' resulted from the ferocious wrath of Rudra (Lord Shiva).

During the ''Treta Yuga'' (second age) Lord Shiva took a vow of not manifesting anger or wrath for one thousand celestial years. During this time the ''asuras'' (the demons) indulged in the creating obstruction, playing mischiefs and destroying the sacrament and the meditation of the ''rishis'' (sages). Daksha Prajapati was capable of combating these demons but he ignored his duties of opposing those demons and further organized a ''yajna'' (ritual of sacrifice) in which he did not offer any share to Lord Shiva in spite of being told to do so by the other lords. He even did not chant the hymns (''richa'') described in the ''veda'' of lord Shiva which provide fulfilment to the desired objective of ''yajna'' and even did not offer ''ahuti'' (pouring of ghee in the sacrificial fire) to Lord Shiva. Lord Shiva perceived whole of this situation regarding Daksha Prajapati’s non observance of rules and became angry. He then brought forward his ''Raudra'' (wrathful) ''bhava'' (nature) and opened his third eye, destroying all those demons by burning them and further gave rise to a child like form named ''Virabhadra'' to his wrath, who was stuffed with his anger and was capable of destroying the ''yajna'' of Daksha. That child demolished the ''yajna'' of Daksha Prajapati as a result of which the gods got afflicted with burning sensation and pain and started running in different directions and became afflicted. Then the gods along with the seven rishis offered those substantial hymns to Lord Shiva till he became pleased and switched over to his Shiva (the compassionate or benevolent and auspicious) form. When it was known that Lord Shiva is returned to his auspicious disposition, then Virabhadra who was produced from the wrathful fire of Lord Shiva, who had three heads and nine eyes, used ash as his weapon, had the flame of his fire as his garland, was wrathful, had frightful and small thighs and stomach approached lord Shiva with folded hands and enquired about his future work. Lord Shiva replied to him that “you will become ''jwara'' in this world and afflict people in the beginning of life – at birth and at the time of death and will also afflict those who will resort to erratic regimen.”[14-25]

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=== ''Prabhava'', the sequels of the disease ===

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prakRutishca pravRuttishca prabhAvashca pradarshitaH|27|

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''Santapa'' (feeling of heat or raised temperature), ''aruchi'' (anorexia), ''trishna'' (morbid thirst), ''angamarda'' (body ache), ''hrid vyatha'' (pain in the cardiac region) – these are the invariable manifestations of ''jwara''. At the time of birth and death, ''jwara'' is manifested in the form of tamas (''moha''- altered state of consciousness). In this way the ''prakriti'' (nature), ''pravritti'' (origin) and the ''prabhava'' (invariable manifestations) of ''jwara'' are described. [26-27]

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nidAne kAraNAnyaShTau pUrvoktAni vibhAgashaH||27||

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Earlier in the [[Nidana Sthana]] the etiological factors for each of the eight varieties of ''jwara'' have been described separately. [27]

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=== Premonitory symptoms of ''jwara'' ===

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shIlavaikRutamalpaM ca jwaralakShaNamagrajam||29||

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Laziness, lacrimation, yawning, heaviness, mental fatigue, uncertainty and intolerance about the liking and disliking for the heat, sun, wind and water; indigestion, anorexia, depletion in strength, complexion, and slight change in conduct, are the premonitory signs and symptoms of ''jwara''.[28-29]

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=== Sites of ''jwara'' ===

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sharIraM, balakAlastu nidAne sampradarshitaH||30||

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The whole body and the mind are the sites of manifestation of ''jwara''. The severity and the time of manifestation of ''jwara'' have been described in [[Nidana Sthana]].[30]

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=== Cardinal feature ===

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jvareNAvishatA bhUtaM na hi ki~jcinna tapyate||31||

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The clinical features invariably associated with ''jwara'' are the feeling of heat or increased body temperature and discomfort in body and mind. ''Jwara'' afflicts the whole body including mind and sensory organs in all living beings. [31]

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=== Classification ===

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bhinnaH kAraNabhedena punaraShTavidho jwaraH||35||

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''Jwara'' is classified into two types each on the basis of the following criteria –

*''Sharira'' (physical) and ''manasa'' (mental)

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''Jwara'' is classified into eight types on the basis of eight causes of ''jwara'' (''dosha'' predominance). [32-35]

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=== Clinical features of somatic and psychic ''jwara'' ===

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indriyANAM ca vaikRutyaM j~jeyaM santApalakShaNam|37|

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The ''sharira'' type of ''jwara'' first appears in the body and the ''manasa'' type, first appears in the mind. ''Vaichitya'' (mental instability), ''arati'' (disliking for everything) and ''glani'' (feeling of weakness in the body) are the signs and symptoms of the ''manas tapa'' (mental affliction of ''jwara''). The loss of ease in sensing the objects is the feature of the ''santapa'' of the ''indriya''. [36-37]

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=== Desires of patient to diagnose ''dosha'' dominance ===

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icchatyubhayametattu jvaro vyAmishralakShaNaH|38|

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A patient suffering from ''vatapittaja'' variety of ''jwara'' desires for cold things, while, a patient suffering from ''jwara'' caused by ''vata'' and ''kapha dosha'' longs for hot things. However, when both of these types of ''doshas'' get mixed then such patient manifests both the kinds of symptoms. [37-38]

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=== Attenuating nature of ''vata dosha'' ===

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dAhakRuttejasA yuktaH, shItakRut somasaMshrayAt|39|

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''Vata dosha'' is exceedingly ''yogavahi'' (which accentuates the properties of others) in nature. It produces both type of effects on combination with the two ''doshas''. On combining with ''tejas'' it produces burning sensation while in combination with ''soma'' it produces cooling effect. [38-39]

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=== Features of internal and external ''jwara'' ===

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bahirvegasya li~ggAni sukhasAdhyatvameva ca||41||

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Excessive burning sensation inside the body, morbid thirst, delirium, dyspnea, giddiness, pain in bones and joints, absence of sweating, non-excretion of ''doshas'' and the feces – are the clinical features of ''antarvegi jwara'' (internal manifestation of ''jwara'').

Excessive rise in the body temperature and above features in mild form are the features of ''bahirvegi'' (external type of ''jwara'') and this type of ''jwara'' is easily curable. [39-41]

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=== ''Prakrita jwara''(seasonal ''jwara'') ===

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hetavo vividhAstasya nidAne sampradarshitAH||49||

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''Jwara'' manifesting in the ''vasanta'' or spring season and ''sharada'' or autumn season is called ''prakrita'' (seasonal) ''jwara'' and is easily curable.

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The causative factors of the different types of ''jwara'' have been described in [[Nidana Sthana]] (in ''jwara''). [42-49]

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=== Prognosis of ''jwara'' ===

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==== ''Sadhya'' (curable) ''jwara'' ====

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''Jwara'' is easily curable if it occurs in a person with strong physique, or if it is caused by the vitiation of lesser amount of ''dosha'' and if there are no complications.

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''Jwara'' occurring in a weak and emaciated person (''kshina''), associated with edema (''shunasya''), seated in deeper body tissues (''gambhira''), severe (''balvan'') and that occurring for very long durations (''dirgha ratrika'') are incurable ones. The ''jwara'' in which, the mid hair part of scalp becomes visible, is also considered incurable (''kesha simanta krita'').[49-53]

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=== Five types of ''jwara'' as per frequency ===

==== ''Santata jwara'' ====

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kriyAkramavidhau yuktaH prAyaH prAgapatarpaNaiH|61|

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The aggravated ''dosha'' circulate through the channels carrying ''rasa'' (the first nutritional dhatu equivalent to plasma) and spread all over the body and gets stagnated, causes ''santata jwara''. This ''santata jwara'' is extremely difficult to treat and manifests its symptoms very quickly. In this type the patient either gets cured (on the pacification of ''dosha'') or killed (on the further aggravation of ''dosha'') on the 10th, 12th or 7th day.

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If, some of the 12 constituents of this fever get purified, while some others remain unpurified, then the fever goes in latent stage on the 12th day and reappears on the 13th day and may persist for longer duration. In this way, a physician should understand the causes and features of this type of fever and should initiate the treatment only after a proper understanding of these factors, mostly by the methods beginning with ''apatarpana''. [53-61]

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==== ''Satata jwara'' ====

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ahorAtre satatako dvau kAlAvanuvartate||62||

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The aggravated ''dosha'' when generally lodges in the ''rakta dhatu'', then they manifest with fever twice in 24 hours (Nycthemeron) depending on the time of ''dosha'' aggravation or subsidence. The ''dosha'' in this type of ''jwara'' can be counteracted. [61-62]

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==== ''Anyedyushka jwara'' ====

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sapratyanIko janayatyekakAlamaharnishi|

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Vitiated ''dosha'' produce ''anyedushka'' type of ''jwara'' with the support of any one factor amongst the ''kala'' (time), ''prakriti'' (physical constitution) and ''dushya'' (vitiated factors) leading to obstruction in ''medo vaha sira'' (the channel of circulation of ''medasa'' (fat)). It can be counteracted. This ''jwara'' occurs only once during day and night. [63-64]

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==== ''Tritiyaka'' and ''chaturthaka jwara'' ====

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dinadvayaM yo vishramya pratyeti sa caturthakaH||67||

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When the ''dosha'' afflict the ''asthi dhatu'' (bone tissue) and ''majja dhatu'' (bone marrow), they cause the ''tritiyaka'' and ''chaturthaka jwara'' respectively.

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''Anyedushka jwara'' occurs every day, while ''tritiyaka jwara'' occurs after a gap of one day and ''chaurthaka'' occurs after two days gap. [64-67]

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=== Cause of alterations in ''jwara'' episodes ===

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ja~gghAbhyAM shlaiShmikaH pUrvaM shirasto~anilasambhavaH||72||

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As a seed remains dormant in the soil and germinates at a favorable time, similarly the ''doshas'' remain in dormant condition in the ''dhatu'' and get aggravated at a favorable time. These ''dosha'' gain strength at an appropriate time and when the power of the inhibiting (disease preventing) factors has subsided, then the ''tritiyaka'' and ''chaturthaka jwara'' manifest.

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*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]

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trividho dhAturekaiko dvidhAtusthaH karoti yam||73||

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''Chaturthaka viparyaya jwara'' is another variety of ''vishama jwara''. Each of the three ''dosha'' i.e. ''vata, pitta'' and ''kapha'' cause this disease by afflicting the two dhatu viz ''asthi'' (bone) and ''majja'' (bone marrow).[73]

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sannipAte tu yo bhUyAn sa doShaH parikIrtitaH||74||

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These five types of ''jwara'' are mostly caused by ''sannipata'' (simultaneous vitiation of the three ''dosha''), however, the ''dosha'', which is predominant among the three ''doshas'' is generally attributed as the causative factors. [74]

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=== ''Dhatugata jwara'' ===

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asthimajjagataH kRucchraH shukrastho naiva siddhyati||83||

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Manifestation of ''jwara'' at a particular time or a change in the time of manifestation takes place due to following factors:

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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]

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=== Clinical features of ''jwara'' due to combination of two ''dosha'' ===

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ityete dvandvajAH proktAH ...|89|

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Signs and symptoms of ''jwara'' by combination of ''vata'' and ''pitta'':

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Thus, here the features of different types of ''jwara'' caused by the simultaneous vitiation of two ''dosha'' have been described. [84-89]

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=== ''Sannipataja jwara'' ===

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cirAt pAkashca doShANAM sannipAtajwarakRutiH|109|

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Description of ''sannipataja jwara'' (caused by combined ''tridosha''):

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**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]

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=== Prognosis of ''sannipata jwara'' ===

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saMsargasannipAtAnAM tayA coktaM svalakShaNam|111|

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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'' types can be known and decided. [109-110]

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=== Classification of ''agantuja jwara'' ===

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abhighAtAbhiSha~ggAbhyAmabhicArAbhishApataH|

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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]

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=== ''Abhighataja jwara'' (due to injury or trauma) ===

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savyathAshophavaivarNyaM karoti sarujaM jvaram|114|

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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]

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=== ''Abhishangaja, abhishapaja'' and ''abhicharaja jwara'' ===

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hētvauṣadhaviśiṣṭāśca bhavantyāgantavō jvarāḥ|129|

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'''''Abhishangaja jwara''''': ''Jwara'' caused by the affliction of passion, grief, fear, anger and evil spirits including germs is called ''abhishangaja jwara''. ''Vata'' gets aggravated by passion, grief and fear, while pitta is aggravated by anger and all the three ''doshas'' are afflicted by ''bhootas'' (evil spirits or germs). Simultaneously, the signs and symptoms of the respective type of ''bhoota'' are described here. In the ''bhutadhikara'' section, the characteristic features of eight types of ''bhoota'' are described.

Some ''acharyas'' opine that the ''jwara'' caused by the contact of the poisonous air of the toxic plants and other such toxins is called ''abhishangaja jwara''. This type of ''jwara'' gets cured by the administration of antidotes of this poison.

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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 etiological factors and treatments. [114-129]

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=== General patho-physiology of ''jwara'' ===

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bhavatyatyuShNasarvA~ggo jvaritastena cocyate|132|

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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]

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=== Cause of lack of sweating ===

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svasthAnAt pracyute cAgnau prAyashastaruNejvare|133|

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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]

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=== Clinical features of ''Ama Jwara'' (first stage of ''jwara'') ===

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na viD jIrNA na ca glAnirjvarasyAmasya lakShaNam|

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The ''ama jwara'' (first stage of ''jwara'') presents with the following clinical features –

*Anorexia, indigestion, heaviness in the stomach

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*Improper formation of stool

*Absence of muscle emaciation [133-136]

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=== Clinical features of ''pachyamana jwara'' (second stage of ''jwara'') ===

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malapravRuttirutkleshaH pacyamAnasya lakShaNam|137|

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The features of ''pachyamana jwara'' (second stage of fever) are as follows – high grade fever and excess thirst, delirium, dyspnea, giddiness and excess evacuation of wastes [136]

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=== Clinical features of ''nirama jwara'' (third stage of ''jwara'') ===

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doShapravRuttiraShTAho nirAmajvaralakShaNam|138|

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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]

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=== Precaution at initial stage of ''jwara'' ===

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krodhapravAtavyAyAmAn kaShAyAMshca vivarjayet|139|

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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]

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=== Contra-indications of ''langhana'' (fasting) ===

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kShayAnilabhayakrodhakAmashokashramodbhavAt |140|

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''Langhana'' or fasting is prescribed in the initial stage of ''jwara'' except those caused by ''kshaya'' (consumption), ''vata'' dominant ''jwara'', fear, anger, passion, grief and physical exertion.[139-140]

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=== Benefits of ''langhana'' (fasting) in ''jwara'' ===

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balAdjhiShThAnamArogyaM yadartho~ayaM kriyAkramaH|142|

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''Langhana'' reduces the aggravated ''dosha'' and stimulates the ''agni'', as a result of which ''jwara'' subsides and the body becomes light and the person’s appetite is restored.

''Langhana'' should be performed to the extent that it does not hamper the vitality or strength of the individual. The aim of all these measures is to regain the health which also depends on the physical, mental and spiritual strength. [140-142]

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=== Management principle of ''jwara'' ===

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srotasAM shodhanaM balyaM rucisvedakaraM shivam|145|

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If the patient of ''jwara'' feels thirsty, he should be given :

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Both of these are ''dipana'', (digestive stimulant), ''pachana'' (enhancing digestion), and ''jwaraghna'' (alleviators of ''jwara''). They help in cleansing the channels of circulation and promote strength, appetite, sweating and auspiciousness. [143-145]

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=== ''Shadanga paniya'' ===

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shRutashItaM jalaM dadyAt pipAsAjvarashAntaye|146|

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Patient should be given water cooled after boiling it with ''musta, parpataka, ushira, chandana, udichya'' and ''nagara'' for the alleviation of thirst and ''jwara''. [145]

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=== Indication of ''vamana'' (therapeutic emesis) ===

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buddhvA jvarakarAn kAle vamyAnAM vamanairharet|147|

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If the ''jwara'' is predominantly caused by vitiated ''kapha dosha'', located in the ''amashaya'' (stomach) and is in a stage of ''utklesha'' (in a stage of being on the verge of coming out of its place), then it should be eliminated by the administration of emetics.

Note: The status of ''kapha'' should be ascertained clearly before the administration of drug and emetics should be given only to those patients who are found suitable for emesis.[147]

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=== Hazards of improper ''vamana'' (therapeutic emesis) ===

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doShAH phalAnAmAmAnAM svarasA iva sAtyayAH|149|

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If ''vamana'' (emesis) is administered to a ''jwara'' patient in whom the ''dosha'' have not attained the stage of ''utklesha'' (verge of coming out), then they may cause acute form of heart disease, dyspnea, ''anaha'' (obstruction to the movement of flatus and feces) and illusion. Attempting to take out the ''anupasthita dosha'' (unprepared to be eliminated) from the body of a person bring complications for the person and is just like attempting to take out juice from a raw fruit which creates complications (destroys the fruit). [147-149]

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=== Post ''vamana'' protocol ===

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jvaraghnyo jvarasAtmyatvAttasmAt peyAbhirAditaH||153||

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The patient after being given emesis and kept on fasting should be administered ''yavagu'' (a gruel preparation) prepared by boiling with the drugs mentioned further, in appropriate time. Before administering ''yavagu'', the patient should be given ''manda'' (extremely thin gruel). This should be continued by the wise for either six days or till the ''jwara'' becomes mild.

Line 2,392: Line 2,395:

In view of above, a ''jwara'' patient should in the beginning be administered with different types of ''peya'' (thin gruels). [149-153]

−

+

</div>

=== Contra-indications of ''yavagu'' ===

Line 2,415: Line 2,418:

Urdhvage raktapitte ca yavAgUrna hitA jvare|155|

</div></div>

−

+

However, these gruels are contraindicated in the fevers caused by intake of alcohol, in alcoholism, for persons addicted to alcohol, in summer seasons, when there is predominance of ''pitta'' and ''kapha'' and in ''urdhwaga rakta–pitta'' (a disease characterized by bleeding from the different upper channels of the body).[154]

+

</div>

Line 2,432: Line 2,436:

jvarApahaiH phalarasairyuktaM samadhusharkaram|156|

</div></div>

−

+

In cases where ''yavagu'' administration is prohibited, the physician should administer in the beginning ''tarpana'' (nutritional diet) prepared from ''laja saktu'' (powder of roasted grains) mixed with honey, sugar and fruit juices, which have ''jwara'' alleviating properties.[155]

−

+

</div>

=== Guidelines for diet, mouth cleansing and tooth brush ===

Line 2,487: Line 2,491:

mastvikShurasamadyAdyairyathAhAramavApnuyAt|160|

</div></div>

−

+

Depending upon the habituation (''satmya'') and the strength of the patient, after digestion of the ''tarpana'', patient is administered thin soup of ''mudga'' (green gram) or meat of wild animals. During food time, the patient’s teeth should be cleaned with the twig of plants, which should be such that their taste can counteract the taste of the patient’s mouth and is relishing to the patient. Such kind of cleaning of teeth makes the patient feel freshness in his mouth, develops appetite for food and drinks and becomes capable of appreciating the taste of food to be taken. The mouth should be cleaned several times with water after cleaning with twigs. Thereafter the patient should be given ''mastu'' (thin butter milk), sugarcane juice, alcoholic drinks etc. with suitable and appropriate diet.[156-159]

+

</div>

Line 2,504: Line 2,509:

jvaritaM ShaDahe~atIte laghvannapratibhojitam|161|

</div></div>

−

+

The ''jwara'' patient, after six days and having been given light diet to eat, should be administered decoctions, which are either ''pachana'' (stimulant of digestion) or ''shamana'' (alleviator of ''doshas''). [160-161]

−

+

</div>

=== Contra-indications of ''kashaya'' (astringents) ===

Line 2,535: Line 2,540:

yaH kaShAyakaShAyaH syAt sa varjyastaruNajvare|163|

</div></div>

−

+

If, decoctions of astringent drugs are administered to the patient in ''taruna jwara'' (first stage of ''jwara'') stage, then the ''doshas'' do not undergo ''paka'' (digested) and get adhered due to stickiness. This leads to the onset of ''vishama jwara'' (irregular fevers). The term ''kashaya'' has two meanings i.e. the decoction prepared by boiling the drugs and astringent taste. In the first stage of ''jwara'' (''taruna jwara''), the astringent tasted drugs are prohibited. [161-163]

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</div>

=== ''Yusha'' (soup) indications ===

Line 2,554: Line 2,559:

dashAhaM yAvadashnIyAllaghvannaM jvarashAntaye|164|

</div></div>

−

+

The patient should be given light diet along with ''yusha'' (soup) prepared from vegetables and pulses and ''rasa'' (soup) of the meat of animals inhabiting arid regions, for the alleviation of ''jwara'', up to the tenth day. ''Amla'' (sour) things may or may not be added to these ''yusha''. [163-164]

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+

</div>

=== Indications and contra-indications of ''ghrita'' ===

Line 2,597: Line 2,602:

balaM hyalaM nigrahAya doShANAM, balakRucca tat |167|

</div></div>

−

+

Thereafter, in case of less aggravation of ''kapha dosha'' and excess aggravation of ''vata'' and ''pitta dosha'', and in whom the ''dosha'' have reached the ''pakva'' stage (having no ''ama ansha''), ghee should be given to the patients. It is like ''amrita'' (nectar) for them.

Line 2,603: Line 2,608:

Till the features of ''langhana'' appear in the body, the patient should be given light to digest food along with the meat soup of wild animals and birds. This destroys the strength of the ''doshas'' and promotes the strength of the body. [164-167]

−

+

</div>

=== Indication of milk ===

Line 2,620: Line 2,625:

baddhapracyutadoShaM vA nirAmaM payasA jayet|168|

</div></div>

−

+

A patient with the following conditions should be given milk in ''nirama'' stage in the body –

*When the patient has excessive burning sensation and thirst

*If ''vata'' and ''pitta dosha'' predominate the patient is suffering from ''jwara''

*If the dosha are either ''baddha'' (static), or ''prachyuta'' (slightly dislodged). [167]

−

+

</div>

=== Indication of ''virechana'' ===

Line 2,642: Line 2,647:

akShINabalamAMsAgneH shamayettaM virecanaiH|169|

</div></div>

−

+

If the ''jwara'' does not subside by the therapies described before, then ''virechana'' (purgation) should be given for its alleviation provided, the patient is neither emaciated, weak, depleted of muscle tissue nor has reduced digestive power. [168-169]

−

+

</div>

=== Indications of ''niruha'' (enema with decoction) ===

Line 2,685: Line 2,690:

sraMsanaM trInmalAn bastirharet pakvAshayasthitAn|172|

</div></div>

−

+

Neither ''vamana'' (emesis) nor ''virechana'' (purgation) is useful for patients emaciated by fever. It is thus desirable to remove their malas by the administration of milk or ''niruha'' (ununctuous type of medicated enema prepared by decoctions etc.)

Line 2,691: Line 2,696:

Purgation (''stransana'') eliminates ''kapha'' or ''kapha pitta dosha'' from the ''pittashaya'' (lower portion of the stomach and small intestine). ''Basti'' eliminates all the three ''dosha'' lodged in the ''pakwashaya''.[169-170]

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</div>

=== Indication of ''anuvasana'' (unctuous enema) ===

Line 2,708: Line 2,713:

rUkShabaddhapurIShAya pradadyAdanuvAsanam|173|

</div></div>

−

+

In chronic types of fever (''jirna jwara'') ''anuvasana'' type of ''basti'' (medicated enema with oils) should be given in the following conditions –

*When ''kapha'' and ''pitta'' are alleviated

*When there is strong power of digestion

*When there is ununctuousness (''rukshata'') and ''bandhatwa'' (obstruction, compactness) in the feces. [172-173]

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</div>

=== Indications of ''murdha-virechana'' (nasal errhines) ===

Line 2,730: Line 2,735:

jIrNajvare rucikaraM kuryAnmUrdhavirecanam|174|

</div></div>

−

+

''Murdha virechana'' should be done in patients suffering from chronic type of fevers who have heaviness and pain in head, impaired sensoria. This develops relish for food and also the objects. [173-174]

−

+

</div>

=== Various external procedures ===

Line 2,773: Line 2,778:

tva~gmAtrasheShA yeShAM ca bhavatyAganturanvayaH|177|

</div></div>

−

+

''Abhyanga'' (massage), ''pradeha'' (unguentum), ''parisheka'' (sprinkling of water), and ''avagahana'' (bathing) should be done in patients of ''jirna jwara'' (chronic fevers) considering the types of ''jwara'' with their hot and cold types. By these measures the ''bahirmargagata'' (located in the external tissues) ''jwara'' gets alleviated instantaneously. There is a feeling of ease in the body along with the promotion of strength and complexion.

Line 2,779: Line 2,784:

''Jwara'' located in skin and of exogenous nature or types can be treated with same. [174-177]

−

+

</div>

=== Various dietary articles used in treatment ===

Line 2,808: Line 2,813:

yavAgvodanalAjArthe jvaritAnAM jvarApahAH|179|

</div></div>

−

+

Proper line of treatment for the alleviation of ''jwara'' has been described above, the ingredients used for therapies in accordance to the above stated line of treatment has been described further.

For this purpose, ''rakta shali, shashtika'' type of ''purana'' (preserved for over an year) rice are the best and should be given in the form of ''yavagu'' (gruel), ''odana'' (boiled rice), ''laja'' (fried paddy) as these mitigate ''jwara'' of the patient. [177-179]

−

+

</div>

=== Ten types of ''yavagu'' (gruel) in ''jwara'' ===

Line 2,925: Line 2,930:

nAgarAmalakaiH siddhAM ghRutabhRuShTAM jvarApahAm|188|

</div></div>

−

+

*The ''peya'' prepared with ''laja'' (fried paddy) and boiled with ''pippali'' and ''nagara'' is light to digest and should be given to the patient in the beginning of the ''jwara'' when the digestive power is reduced. However, it should be ascertained before administration that the patient is desirous for food before administration.

*If there is movement of bowel and the patient is desirous of sour things, then the ''peya'' described above should be made sour by adding ''dadima'' and should be given along with ''nagara''.

Line 2,936: Line 2,941:

*''Peya'' boiled with ''bala, vrikshamla, kolamla, kalashi'' (''simha pucchi''), ''dhavani'' (''kantakari'') and ''bilva'' should be given to a patient suffering from ''jwara'' associated with sawing pain. (cutting pain).

*''Peya'' prepared by boiling with ''nagara'' and ''amalaka'' fried with ghee and mixed with sugar is ''jwaraghna'' (alleviates ''jwara''). It should be given to a patient suffering from ''asweda'' (absence of sweating), ''anidra'' (sleeplessness) and ''trishna'' (morbid thirst). [179-188]

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+

</div>

=== Indications of soup ===

Line 2,953: Line 2,958:

yUShArthe yUShasAtmyAnAM jvaritAnAM pradApayet|189|

</div></div>

−

+

''Yusha'' is wholesome for some patients of ''jwara''. This ''yusha'' may be prepared from ''mudga, masura, chanaka, kulattha'' and ''makushtha''.[188-189]

−

+

</div>

=== Indications of vegetables ===

Line 2,972: Line 2,977:

karkoTakaM kaThillaM ca vidyAcchAkaM jvare hitam|190|

</div></div>

−

+

The leaves and fruits of ''patola, kulaka'' (''karvellaka''), ''papachelika'' (''patha''), ''karkotaka, kathilla'' (red variety of ''punarnava'') ''shakas'' are useful in the patients of ''jwara''. [189-190]

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+

</div>

=== Indication of animal meat soups ===

Line 3,027: Line 3,032:

bhiSha~gmAtrAvikalpaj~jo [1] dadyAttAnapi kAlavit|194|

</div></div>

−

+

The soup prepared from ''lava, kapinjala'' (white variety of ''tittiri''), ''ena'' (''krishna sara''), ''chakora, upachakraka'' (a variety of ''chakora''), ''kuranga, kala puccha'' (a type of ''harina''), ''harina'' (coppery coloured dear), ''priashata'' (spotted deer) and ''shasha'' (rabbit) are alleviators of ''jwara'' and hence should be given to the patients of ''jwara'' for whom meat is wholesome. These meat soups may be made slightly sour or taken as such. The wise physician should administer these soups at appropriate time.

Some physicians do not advise the meat soups of animals such as ''kukkuta, mayura, tittiri, krauncha'' and ''vartaka'' as they are heavy to digest and hot potency. In ''jwara'' if ''vayu'' gets aggravated because of ''langhana'', then the physician acquainted with the signs of the ''doshas'' should give the meat soup of these animals also at apropriate time.[190-194]

−

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</div>

=== ''Anupana''(beverages) ===

Line 3,048: Line 3,053:

madyaM vA madyasAtmyAya yathAdoShaM yathAbalam|195|

</div></div>

−

+

Hot water should be given to drink to a thirsty person. Depending upon the ''doshas'' involved and the strength of the patient ''madya'' (wines) may be given to those patients for whom it is wholesome. [194-195]

−

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</div>

=== Contra-indications in ''jwara'' ===

Line 3,073: Line 3,078:

annapAnakramaH siddho jvaraghnaH samprakAshitaH||196||

</div></div>

−

+

Food ingredients, which are heavy to digest, hot in potency, with unctuous property, sweet and astringent taste should preferably be avoided in a patient suffering from ''nava jwara'' (the patient of first stage of ''jwara'') in order to facilitate the ''paka'' of the ''doshas''.

So, the diet and drinks, which are wholesome to the patient of ''jwara'' have been described here. [195-196]

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</div>

=== Decoctions indicated in ''jwara'' ===

Line 3,115: Line 3,120:

tRuShNAruciprashamanA mukhavairasyanAshanAH|200|

</div></div>

−

+

Now, we will describe the ''kashayas'' (decoctions), which alleviate ''jwara''. These are as follows:

*''Musta'' and ''parpataka'' can be taken either in the form of decoction (''pakya'') or ''shita kashaya'' (soaking the drugs for overnight period in water and then filtering the content and using the filtrate).

Line 3,123: Line 3,128:

The above mentioned, decoctions which are used for the alleviation of ''jwara'' are ''jwaraghna''. They stimulate the power of digestion, help in the ''pachana'' (metabolic transformation) of the ''doshas''; alleviate thirst, anorexia and cure ''mukha vairasya'' (bad taste of the mouth). [197-199]

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</div>

=== ''Kashaya'' in ''vishama jwara'' ===

Line 3,170: Line 3,175:

santataM satatAnyedyustRutIyakacaturthakAn||203||

</div></div>

−

+

The five types of ''jwara'' named the ''santata, satata, anyedyushka, tritiyaka'' and ''chaturthaka'' are quickly cured by the five types of decoctions made from drugs described below:

Line 3,178: Line 3,183:

#''Kiratatikta, amrita, chandana, vishva bheshaja''; and

#''Guduchi, amalaka'' and ''musta''. [200-203]

+

</div>

Line 3,223: Line 3,229:

pItvA nishisthitaM janturjvarAcchIghraM vimucyate|207|

</div></div>

−

+

The decoction or ''shita kashaya'' of the following drugs should be taken by a person for curing ''jwara:''

Line 3,231: Line 3,237:

The ''shita kashaya'' of ''madhuka, musta, mrudvika, kashmarya, parushaka, trayamana, ushira, triphala,'' and ''katu rohini'', prepared by keeping overnight, immediately cures the ''jwara'' of living beings. [204-207]

+

</div>

Line 3,264: Line 3,271:

trivRutAsharkarAyuktaH pittashleShmajvarApahaH||209||

</div></div>

−

+

The decoction of either ''jati, amalaka'' and ''musta'' or that of ''dhanavayavasakam'' along with ''guda'' (jaggery) should be given to the patient suffering from ''jwara'' where the ''doshas'' are in ''vibaddha'' state (adhered to ''dhatus'').

The decoction of ''triphala, trayamana, mridvika'' and ''katu rohini'' alleviates ''pitta'' and ''shleshma'' and causes the ''anulomana'' of ''doshas''. This decoction when taken along with ''trivrita'' and ''sharkara'' cures ''jwara'' caused by the aggravation of ''pitta'' and ''shleshma''. [207-209]

−

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</div>

=== Formulations used in ''sannipata jwara'' ===

Line 3,333: Line 3,340:

kAsAdiShu ca sarveShu dadyAt sopadraveShu ca||214||

</div></div>

−

+

A decoction prepared from both the varities of ''bruhati, vatsaka, musta, devadaru, mahaushadha,'' and ''kolavalli'' cures ''sannipata jwara''. ''Shati, pushkaramula, vyaghri, shringi, duralabha, guduchi, nagara, patha, kirata, katurohini'' - all together are called by the name of ''shatyadi varga''. The decoction made from these drugs helps in curing ''sannipāta jwara'' along with ''kasa'' (coughs), ''hrid graham'' (a kind of heart disease), ''parshva arti'' (pain in the flanks), ''shvasa'' (breathlessness) and ''tandra'' (drowsiness).

Both the varieties of ''brihati, paushkar, bhaargi, shathi, shringī, duraalabha,'' seeds of ''vatsaka, patola'' and ''katu rohini'' – are together called the ''brihatyadi gana'' and the decoction made from it cures the ''sannipata jwara''. And is also useful in complications like ''kasa''. [210-214]

+

</div>

Line 3,352: Line 3,360:

nirdiShTA bheShajAdhyAye bhiShaktAnapi yojayet||215||

</div></div>

−

+

Different types of decoctions and gruels are also described in the first four chapters of [[Sutra Sthana]] which also cure ''pipasa'' (thirst) and ''jwara''. They may also be used by the physician for the treatment of ''jwara''. [215]

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</div>

=== Advantage of ghee ===

Line 3,383: Line 3,391:

yaH syAdanubalo dhAtuH snehavadhyaH [1] sa cAnilaH||217||

</div></div>

−

+

If in a person of ununctuous disposition, jwara doesn’t get cured by the use of decoctions, emesis, fasting and by light diet, then ''jwara'' in such a person should be cured by the use of medicated ''ghrita'' (ghee). ''Jwara'' is manifested by ununctuous state of ''tejasa'' in such a person and a patient suffering from ''jwara'' further develops ununctuousness due to the action of this ''tejasa'' (''pitta''). The ''vata'' gets aggravated due to the action of this ''tejasa'' and it can be corrected by the use of some unctuous material like ''ghrita''. [216-217]

+

</div>

Line 3,400: Line 3,409:

prayojyA jvarashAntyarthamagnisandhukShaNAH shivAH||218||

</div></div>

−

+

''Ghrita'' 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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+

</div>

=== Various medicated ghee formulations ===

Line 3,443: Line 3,452:

aMsAbhitApamAgniM ca viShamaM sanniyacchati||221||

</div></div>

−

+

Medicated ''ghrita'' prepared by boiling with ''pipali, chandana, musta, katurohini, kalingaka, tamalaki'' (''bhumyamalaki''), ''sariva, ativisha, sthira, draksha, amalaka, bilva, trayamana'' and ''nidigdhika'' cure chronic types of ''jwara'' instantaneously. It also cures ''kshaya'' (consumption), ''kasa'' (coughs), ''shirahshula'' (headache), ''parshvashula'' (pain in the sides of chest), ''halimaka'' (a type of jaundice), ''ansabhitapa'' (burning sensation in the scapular region) and ''vishama agni'' (irregularity in the power of digestion). [219-221]

+

</div>

Line 3,472: Line 3,482:

kalkIkRutaishca vipaceddhRutaM jIrNajvarApaham||223||

</div></div>

−

+

''Ghrita'' prepared from the decoction made by boiling ''vasa, guduchi, triphala, trayamana'' and ''yavasaka'', milk in double the quantity, paste of ''pippali, musta, mridvika, chandana, utpala'' and ''nagara'' cures chronic fevers.[222-223]

+

</div>

Line 3,513: Line 3,524:

kShayakAsashiraHshUlapArshvashUlAMsatApanut ||226||

</div></div>

−

+

''Ghrita'' prepared from boiling the decoction of ''bala, shvadamstra, brihati, kalasi, dhavani, sthira, nimba, parpataka, musta, trayamana'' and ''duralabha''; paste of ''tamalaki, shati, draksha, pushkarmula, meda'' and ''amalakī'', ghee and milk; is an excellent medicine for the treatment of ''jwara''. It also cures ''kshaya'' (consumption), ''kasa'' (coughs), ''shirahshula'' (headache), ''parshvashula'' (pain in the sides of chest), ''halimaka'' (a type of jaundice), ''ansabhitapa'' (burning sensation in the scapular region. [224-226]

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</div>

=== Formulations used in purification therapies ===

Line 3,604: Line 3,615:

payo~anupAnamuShNaM vA pItvA drAkShArasaM naraH||233||

</div></div>

−

+

Elimination therapies (of ''doshas''), both in upward and downward routes should be administered at appropriate time, to a patient suffering from ''jwara'', having more aggravated ''doshas''. Details of these methods and the formulations used for them will be discussed in the [[Kalpa Sthana]].

Line 3,621: Line 3,632:

*''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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</div>

=== Formulations with medicated milk ===

Line 3,698: Line 3,709:

peyaM taduShNaM shItaM vA yathAsvaM bheShajaiH shRutam||239||

</div></div>

−

+

A patient suffering from ''chira jwara'' (chronic type of fevers), ''kasa, shvāsa, shirahshula'' and ''parshvashula'' gets cured by taking milk boiled with ''panchamula'' (''bilva'' and ''shyonaka, gambhari, patala'' and ''ganikarika'').

Line 3,712: Line 3,723:

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

−

+

</div>

=== Medicated enemas ===

Line 3,885: Line 3,896:

siddhaH sneho jvaraharaH snehabastiH prashasyate||253||

</div></div>

−

+

''Niruha'' and ''anuvasana'' types of ''bastis'' (medicated enemas) which will be described in the [[Siddhi Sthana]] should be administered when the ''doshas'' are lodged in the ''pakvashaya'', for the treatment of ''jwara''.

Line 3,901: Line 3,912:

The ''sneha'' boiled with ''chandana, aguru, kashmarya, patola, madhuka'' and ''utpala'' is exceedingly useful for the administration as ''anuvasana basti'' to cure ''jwara''. [241-253]

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</div>

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

Line 3,930: Line 3,941:

mAtrAshitIye nirdiShTAH prayojyAstA jvareShvapi||255||

</div></div>

−

+

Drugs for ''shirovirechana'' therapy (module of taking out the ''doshas'' from the ''uttamānga - shira'') are already described in the ''Bheshaja Chatushka'' of [[Sutra Sthana]] and [[Rogabhishagjitiya Vimana]] of [[Vimana Sthana]]. A physician well versed in these treatment modules should apply them for the treatment of ''jwara''.

The medicated oil and the ''dhuma varti'' described for application as nasal drop and ''dhuma varti'' respectively in [[Matrashiteeya Adhyaya]], should also be used for the treatment of ''jwara''.[254-255]

−

+

</div>

=== External applications ===

Line 3,963: Line 3,974:

dAhajvaraprashamanaM dadyAdabhya~jjanaM bhiShak||257||

</div></div>

−

+

''Abhyanga'' (massage), ''pradeha'' (unction) and ''parisheka'' (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 ''ghrita'' called as ''Sahasra dhauta ghrita'' 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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</div>

=== ''Chandanadya taila'' ===

Line 4,017: Line 4,028:

madhvAranAlakShIradadhighRutasalilasekAvagAhAshca sadyo dAhajvaramapanayanti shItasparshatvAt||259||

</div></div>

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Now, ''Chandanadya taila'' preparation will be described – ''chandana'' (red variety of ''chandana''), ''bhadrashri'' (white variety of ''chandana''), ''kalanusarya, kaiyaka, padma, padmaka, ushira, sariva, madhuka, nagapushpa, udichya, vanya, padma, utpala, nalina'' (a white variety of ''padma''), ''kumuda''; ''saugandhika, pundarika, shata patra, bis, mrinala, shaluka, shaivala, kasheruka, ananta, kusha, kasa, ikshu, darbha, shara, nala'' – root of ''shali, jambu, vetasa, vanira'' (a variety of ''vetasa'' which do not have fragrant root), ''gundra, kakubha, asana, ashvakarna'' (a variety of ''shala''), ''syandana'' (''nemi vriksha''), ''vatapotha'' (''palasha''), ''shala, tala, dava, tinisha'' (''vanjula''), ''khadira, kadara'' (''vitkhadira''), ''kadamba,'' fruit of ''kashmarya, sarja, plaksha, vata'' (the variety without any adventitious root), ''kapitana'' (popularly known as ''gandhamunda''), ''udumbara, ashvattha, nyagodhra, dhataki, durva, itkata, shringataka, manjishtha, jyotishmati'' (''kanganika''), seeds of ''pushkara, karunyachandana, badari, kovidara, kadali, samvartaka, ariṡṭa'' (a variety of ''neem'' growing in the hills), ''shataparva'' (''bibhitaka''), ''shita kumbhika'' (''kashtha patala''), ''shatavari, shriparni, shravani, mahashravani'' (''alambusha'' – having big fruits), ''rohini, seeta paki'' (''ganda durva''), ''odana paki'' (''neela bhendi''), ''kala'' (''kakoli''), ''bala, payasya, vidari, jeevaka, rishabhaka, meda, mahameda, madurasa, rishyaprokta'' (''riddhi''), ''trina shunya'' (''ketaki''), ''mocharasa, atarushaka, bakula, kutaja, patola, shalmali, narikela, kharjura, mridvika, priyala, priyangu, dhanvana, atmagupta, madhuka,'' and such other drugs which are cold in potency. Also, the drugs which have the same cooling effect can also be added to prepare this decoction, using double the quantity of water. The ''kalka'' (paste) of all the above mentioned drugs must also be taken. Oil mixed with the above stated decoction and paste should be boiled on mild fire till half the quantity is left.

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The ''seka'' and ''avagaha'' (sprinkling of water and bathing) with ''madhu, aranala'' (sour gruel), milk, curd, ''ghrita'' and water cure ''daha jwara'' instantaneously, because of their cold touch.[258-259]

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</div>

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

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vAyavashcandrapAdAshca shItA dAhajvarApahAH||266||

</div></div>

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A patient of ''jwara'' suffering from burning sensation should reside in a house cooled by the leaves of ''puṡkara, padma, utpala, kadalī'' or ''kṡauma''. The house can also be cooled by cold water of sandalwood or the patient can also reside in a ''dhāra gṛha'' (a house cooled by running water either flowing from above or falling from the roof) or a house cooled by ice cool water. This gives comfort to the patient. His body should be touched with the pleasant touch of gold or conch shell or coral or jewels and pearls which are cooled by the sandalwood water. He should be made to wear the garlands made of ''nīlotpala'' or ''padma'' and fanned with the cold air from different types of fans which are cooled with sandalwood water.

Line 4,128: Line 4,139:

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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</div>

=== ''Agurvadya tailam'' ===

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ityagurvAdyaM tailam

</div></div>

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Now, we will explain the therapies for patients of ''jwara'' for whom hot treatment is desirable –

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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 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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</div>

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

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shItajvaraM jayantyAshu saMsargabalayojanAt||271||

</div></div>

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Thirteen varities of ''sweda'' procedures have been described in the [[Swedadhyaya]] of [[Sutra Sthana]]. A physician who is well versed with the proper duration of ''sweda'' as suitable to the season and person should administer them for the treatment of ''shīta jwara''.

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Different types of diet and drinks which cause fomentation and alleviate ''vata'' and ''kapha'', instantaneously alleviate ''sheeta jwara''. These should be administered keeping in view of the ''samsarga'' (combination of two ''doshas'') and the ''bala'' of each ''dosha''. [268-271]

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</div>

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

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la~gghanaM na hitaM vidyAcchamanaistAnupAcaret||272||

</div></div>

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''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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</div>

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

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AdashAhamupakramya kaShAyAdyairupAcaret|283|

</div></div>

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The aggravated ''doshas'' afflict the ''rasa dhatu'' and displace the ''agnī'' from the ''āmāshaya'', for causing ''jwara''. Thus, such patients have less of ''agni'' (digestive strength). Even if a rice pot is kept on burning fire with enough fuel, the rice will not get cooked if the fire is blown out by a strong wind. Similarly, in a patient of ''jwara'', the ''ūṡmā'' (digestive fire) is blown out of the ''paktī sthāna'' (place of digestion) and in this condition the consumed food is not digested properly. If the food is light, then also it gets digested with difficulty. Therefore, the line of treatment in ''jwara'' of ''langhana'' is useful for the preservation of the power of digestion.

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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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</div>

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

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kaphasthAnAnupUrvyA vA sannipAtajvaraM jayet|287|

</div></div>

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''Langhana'' and similar other therapies described in [[Langhanabrimhaniya Adhyaya]] of [[Sutra Sthana]] should be invariably administered in the following conditions:

*When the ''jwara'' is in the ''sama'' stage

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

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</div>

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

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pradehaiH kaphapittaghnairnAvanaiH kavalagrahaiH|289|

</div></div>

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A serious outcome of the ''sannipataja jwara'' is inflammation near the root of the ears which is a very serious condition and very few of such patients 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), ''navana'' (nasal instillation) and ''kavala graham'' (mouthful of liquid medication). [287-289]

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</div>

=== Indications of blood letting ===

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shAkhAnusArI raktasya so~avasekAt prashAmyati|290|

</div></div>

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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]

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</div>

=== Indication of consumption of ghee ===

Line 4,515: Line 4,526:

tatrAdau sarpiShaH pAnaM kaphapittottaro na cet|291|

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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 dosha'' are not aggravated. [290-291]

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</div>

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

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balyeH sambRuMhaNaistasmAdAhAraistamupAcaret|292|

</div></div>

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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]

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</div>

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

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kaShAyoShNaM ca viShame jvare shastaM kaphottare|296|

</div></div>

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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 bastīs'' (medicated enemas), unctuous and hot diet and drinks. When the ''pitta dosha'' 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, ''pachana'' (therapy which promotes the digestion and metabolism), ununctuous diet and drinks, fasting and hot decoctions are useful. [292-296]

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</div>

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

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dhAraNAdagadAnAM ca sevanAnna bhavejjvaraH|310|

</div></div>

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Formulations which are effective in curing ''jwara'' are being described. A wise physician should administer them, keeping in view their suitability for the type of ''dosha'' involved. These recipes are as follows –

*''Sura'' along with its ''manda'' (alcohol along with its supernatant part) as drink

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

*Intake of ''agada'' (antidote like drugs).[296-309]

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</div>

=== Spiritual therapy ===

Line 4,847: Line 4,858:

jvarAdvimucyate shIghraM sAdhUnAM darshanena ca|

</div></div>

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Prayers should be offered to lord Ishvara along with Umā, their attendents and matṛs. This immediately cures ''viṡama jwara''.

Line 4,855: Line 4,866:

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]

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</div>

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

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asthimajjagate deyA nirUhAH sAnuvAsanAH|317|

</div></div>

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When the ''doshas'' causing ''jwara'' are located in –

*the ''rasa dhātu'', then ''vamana'' and ''upavāsa'' (emesis and fasting) should be done.

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*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]

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</div>

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

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daivavyapAshrayaM tatra sarvamauShadhamiShyate|

</div></div>

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

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</div>

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

Line 4,940: Line 4,951:

kShatAnAM vraNitAnAM ca kShatavraNacikitsayA|

</div></div>

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''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]

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</div>

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

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tasyeShTaistu vicitraishca viShayairnAshayet smRutim|324|

</div></div>

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The ''jwara'' caused by ''kāma'' (passion), ''shoka'' (grief) and ''bhaya'' (fear) gets cured by the ''āshvāshana'' (assurance), ''ishṭa labha'' (providing the desired object), alleviation of ''vāyu'' and ''harshana'' (bringing excitement).

Line 5,003: Line 5,014:

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]

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

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teShAmadAruNo mokSho jvarANAM cirakAriNAm||328||

</div></div>

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The clinical features manifested at the time of remission of (''sannipata jwara'') are – the patient produces ''kujana'' (rumbling) sound, vomiting, abnormal movements of the limbs (''cheshta''), heavy breathing or difficulty in breathing, discoloration, ''svinna anga'' (sweating), trembling (''vepate''), frequent fainting (''lihyate muhuḥ''), delirium, the body becoming very hot and cold at times, unconsciousness, more rise of temperature, angry appearance and forceful passage of liquid stools mixed with ''doshas'' with sound.

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

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</div>

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

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yuktaM prakRutisattvena vidyAt puruShamajvaram||329||

</div></div>

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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]

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

Line 5,134: Line 5,145:

jvaramukto na seveta yAvanna balavAn bhavet||332||

</div></div>

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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]

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

Line 5,275: Line 5,286:

ghnanti pItAni cAbhyAsAt punarAvartakaM jvaram||343||

</div></div>

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If a person, who has become free from ''jwara'', resorts to prohibited factors (as described before) before gaining strength, then the ''jwara'' reappears. If a person becomes free from ''jwara'' when the ''doshas'' have not been eliminated properly, then, even with mild irregularity in regimens (''apachara''), it reappears. As such patients have already suffered for a long time; hence there is weakness and loss of vitality in the tissues. If the fever reappears in them and then this certainly leads to their death.

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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]

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</div>

=== Guidelines for management ===

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jvarAkriyAkramApekShI kuryAttattaccikitsitam||344||

</div></div>

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The wise physician should treat the patient in different stages of ''jwara'', according to the line of treatment of ''jwara''. [344]

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</div>

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tasmAdvisheShatastasya yateta prashame bhiShak||345||

</div></div>

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''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]

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</div>

=== Summary ===

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AtreyeNAgniveshAya bhUtAnAM hitakAmyayA||346||

</div></div>

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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]

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*The signs of regaining health after remission of a disease are disappearance of klama (mental fatigue) and santapa (raised temperature/feeling of heat), absence of pain, clarity of senses and gaining natural mental faculties.

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

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=== Related Chapters ===

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