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{{#seo:

|title=Jwara Chikitsa

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|type=article

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<big>'''[[Chikitsa Sthana]] Chapter 3. Management of Jwara (different types of fever) '''</big>

{{Infobox

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|data7 = Chandola H.M.

|label8 = Editors

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|data8 = Baghel M.S., Deole Y.S., Basisht G.

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|data8 = Baghel M.S., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

|label9 = Year of publication

|data9 = 2020

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}}

<big>'''Abstract'''</big>

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<~~div~~ style="text-align:justify;">This chapter on ''jwara'' is specially important from the standpoint of its management. It covers various endogenous and exogenous causes of ''jwara'' with its management principles. It encompasses a wide set of concepts related to diversified pathogenesis of diseases, including variations in ''[[dosha]]'' states, their degrees in less or severe form, clinical features and their management. The stages of disease and change in treatments need special attention. The important concept of functional aspects of disease involving psychogenic factors and affliction of unknown factors causing ''jwara'' are described in detail with their psycho-spiritual therapies. Do’s and don’ts during jwara and after its remission are applicable in every disease. The etio-pathogenesis and management of recurrence of ''jwara'' denotes importance of observing prescribed codes even after being free from disease. Due to the cardinal feature of raised body temperature or a perception of it, ''jwara'' is often considered synonymous with fever. However, it is not always necessary to consider ''jwara'' disease as fever, because it covers many other principles of management of disease. Modern medicine literature describes two components of fever, one where the cause or etiology is known and the other where it is unknown and is described as FUO (Fever of Unknown Origin). Thus, there is no curative treatment of FUO is available in modern medicine. On the other hand, this chapter describes important Ayurvedic concepts of ''jwara'' or fever which are important to understand the etiology of fever and thus the management.

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<p style="text-align:justify;">This chapter on ''jwara'' is specially important from the standpoint of its management. It covers various endogenous and exogenous causes of ''jwara'' with its management principles. It encompasses a wide set of concepts related to diversified pathogenesis of diseases, including variations in ''[[dosha]]'' states, their degrees in less or severe form, clinical features and their management. The stages of disease and change in treatments need special attention. The important concept of functional aspects of disease involving psychogenic factors and affliction of unknown factors causing ''jwara'' are described in detail with their psycho-spiritual therapies. Do’s and don’ts during jwara and after its remission are applicable in every disease. The etio-pathogenesis and management of recurrence of ''jwara'' denotes importance of observing prescribed codes even after being free from disease. Due to the cardinal feature of raised body temperature or a perception of it, ''jwara'' is often considered synonymous with fever. However, it is not always necessary to consider ''jwara'' disease as fever, because it covers many other principles of management of disease. Modern medicine literature describes two components of fever, one where the cause or etiology is known and the other where it is unknown and is described as FUO (Fever of Unknown Origin). Thus, there is no curative treatment of FUO is available in modern medicine. On the other hand, this chapter describes important Ayurvedic concepts of ''jwara'' or fever which are important to understand the etiology of fever and thus the management. </p>

'''Keywords''': ''Jwara roga, Santapa, [[pitta]]'' fever, ''ushma'', heat regulation.

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*''Sannipataja jwara'' in which vitiated ''[[kapha]]'' predominates over the other two ''[[dosha]]s'' presents with the following signs and symptoms – laziness, anorexia, nausea, burning sensation, vomiting, ''arati'' (restlessness), giddiness, drowsiness and cough. [96]

*''Sannipataja jwara'' in which vitiated ''[[kapha]]'' is excessively vitiated, ''[[pitta]]'' moderately vitiated and ''[[vata]]'' is less vitiated presents with the following clinical features – coryza, vomiting, laziness, drowsiness, anorexia and weak digestion. [97]

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*''Sannipataja jwara'' in which vitiated ''pitta'' is excessively vitiated, ''kapha'' moderately vitiated and ''vata'' is less vitiated presents with the following clinical features – yellowish discoloration of urine and eyes, burning sensation, thirst, giddiness and anorexia. [98]

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*''Sannipataja jwara'' in which vitiated ''[[pitta]]'' is excessively vitiated, ''[[kapha]]'' moderately vitiated and ''[[vata]]'' is less vitiated presents with the following clinical features – yellowish discoloration of urine and eyes, burning sensation, thirst, giddiness and anorexia. [98]

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*''Sannipataja jwara'' in which vitiated ''vata'' is excessively vitiated, ''kapha'' moderately vitiated and ''pitta'' is less vitiated presents with the following clinical features – headache, trembling, breathlessness, delirium, vomiting and anorexia. [99]

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*''Sannipataja jwara'' in which vitiated ''[[vata]]'' is excessively vitiated, ''[[kapha]]'' moderately vitiated and ''[[pitta]]'' is less vitiated presents with the following clinical features – headache, trembling, breathlessness, delirium, vomiting and anorexia. [99]

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*''Sannipataja jwara'' in which vitiated ''kapha'' is excessively vitiated, ''vata'' moderately vitiated and ''pitta'' is less vitiated presents with the following clinical features – coldness, heaviness, drowsiness, delirium and excessive pain in bones as well as head. [100]

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*''Sannipataja jwara'' in which vitiated ''[[kapha]]'' is excessively vitiated, ''[[vata]]'' moderately vitiated and ''[[pitta]]'' is less vitiated presents with the following clinical features – coldness, heaviness, drowsiness, delirium and excessive pain in bones as well as head. [100]

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*''Sannipataja jwara'' in which vitiated ''vata'' is excessively vitiated, ''pitta'' moderately vitiated and ''kapha'' is less vitiated presents with the following clinical features – dyspnoea, cough, coryza, dryness of the mouth and excessive pain in the flanks. [101]

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*''Sannipataja jwara'' in which vitiated ''[[vata]]'' is excessively vitiated, ''[[pitta]]'' moderately vitiated and ''[[kapha]]'' is less vitiated presents with the following clinical features – dyspnoea, cough, coryza, dryness of the mouth and excessive pain in the flanks. [101]

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*''Sannipataja jwara'' in which vitiated ''pitta'' is excessively vitiated, ''vata'' moderately vitiated and ''kapha'' is less vitiated presents with the following clinical features – diarrhea, weak digestion, thirst, burning sensation, anorexia and giddiness. [102]

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*''Sannipataja jwara'' in which vitiated ''[[pitta]]'' is excessively vitiated, ''[[vata]]'' moderately vitiated and ''[[kapha]]'' is less vitiated presents with the following clinical features – diarrhea, weak digestion, thirst, burning sensation, anorexia and giddiness. [102]

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*In ''sannipataja jwara'' with all the three ''~~doshas~~'' vitiated to the same extent, following signs and symptoms are observed:

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*In ''sannipataja jwara'' with all the three ''[[dosha]]s'' vitiated to the same extent, following signs and symptoms are observed:

**Patient has feeling of burning sensation sometimes and sometimes feeling of cold

**Pain in the bones, joints and head

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**Swaying movements of head, thirst, sleeplessness and pain in the cardiac region

**Sweat, urine and stool reduced in amount with delayed evacuation.

−

**Body is not excessively emaciated (due to accumulated ''dosha'')

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**Body is not excessively emaciated (due to accumulated ''[[dosha]]'')

**Constant ''kujana'' (cooing sound)

**Urticaria and bluish – black or reddish circular patches appear on the skin

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**Inflammation of ''srotasa''

**Heaviness in the abdomen

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**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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**The ''[[dosha]]s'' undergo ''paka'' after a very long time (conversion into the healthy state of the ''[[dosha]]s'' do not occur early). [103-109]

</div>

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

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</div></div>

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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.

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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.

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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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The clinical features of ''jwaras'' caused by the individual ''[[dosha]]s [[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]

</div>

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

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</div></div>

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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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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]

</div>

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

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</div></div>

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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.

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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 ''[[dosha]]s'' 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 specific features of ''kama'' etc. as described in the context of ''jwara'' are also applicable to other diseases caused by these factors (as ''unmada'' etc.).

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In ''kama jwara'' etc. the mind is first afflicted by passion etc. but the ''jwara'' does not manifest until the ''~~doshas~~'' as ''vata, pitta, kapha'' of the body are not vitiated. Similarly, the vitiation of the ''~~doshas~~'' in the body also does not gain enough strength to produce ''jwara'' unless the mind is afflicted by these factors (''kama, chinta'' etc.)

+

In ''kama jwara'' etc. the mind is first afflicted by passion etc. but the ''jwara'' does not manifest until the ''[[dosha]]s'' as ''[[vata]], [[pitta]], [[kapha]]'' of the body are not vitiated. Similarly, the vitiation of the ''[[dosha]]s'' in the body also does not gain enough strength to produce ''jwara'' unless the mind is afflicted by these factors (''kama, chinta'' etc.)

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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</div></div>

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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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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]

</div>

=== Cause of lack of sweating ===

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*Feeling of heaviness and accumulation of impurities in cardiac region, drowsiness and laziness

*Continuous, fever with acute onset.

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*Non-elimination of the dosha along with mala or waste products

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*Non-elimination of the [[dosha]] along with [[mala]] or waste products

*Excess salivation, nausea, loss of appetite, and tastelessness in the mouth

*Rigidity, numbness and heaviness of the body

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</div></div>

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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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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]

</div>

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

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</div></div>

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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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''[[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]

</div>

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

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

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</div></div>

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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.

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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.

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''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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''[[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]

</div>

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

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</div></div>

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''Langhana'' (fasting), ''swedana'' (fomentation), ''kala'' (waiting period of eight days), ''yavagu'' (medicated gruels) and ''tikta rasa'' drugs (drugs having bitter taste) and all digestive enhancers of ''avipakva dosha'' (untransformed) are prescribed in the ''taruna jwara'' (the initial stage of ''jwara'').[142]

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''[[Langhana]]'' (fasting), ''[[swedana]]'' (fomentation), ''kala'' (waiting period of eight days), ''yavagu'' (medicated gruels) and ''tikta rasa'' drugs (drugs having bitter taste) and all digestive enhancers of ''avipakva [[dosha]]'' (untransformed) are prescribed in the ''taruna jwara'' (the initial stage of ''jwara'').[142]

=== Various drinks for management of thirst ===

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

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Hot water to drink if the ''jwara'' caused by aggravation of ''vata'' and ''kapha'';

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Hot water to drink if the ''jwara'' caused by aggravation of ''[[vata]]'' and ''[[kapha]]'';

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If the ''jwara'' is ''pitta'' dominant or if it occurs as a result of intake of alcohol, water boiled with bitter drugs and then cooled, is given.

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If the ''jwara'' is ''[[pitta]]'' dominant or if it occurs as a result of intake of alcohol, water boiled with bitter drugs and then cooled, is given.

−

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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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]

</div>

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

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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]

</div>

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

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

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</div></div>

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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.

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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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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]

</div>

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

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

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</div></div>

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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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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]

</div>

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

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=== Post ''[[vamana]]'' protocol ===

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As the addition of ''samidha'' (fuel) accelerates the fire, similarly the digestive fire also becomes stimulated by the consumption of gruels. These gruels are inherently light for digestion and they further stimulate the ''agni'' due to the addition of drugs to it.

−

These help in ''anulomana'' (elimination through the downward movement) of flatus, urine, feces and ''~~doshas~~''. Being liquid and hot they also cause sweating. Being watery in nature they also alleviate thirst. Due to their nourishing property as a diet, they sustain the ''prana'' (vitality) and cause lightness of the body because of their laxative property. They bring down the ''jwara'' and are also wholesome for the ''jwara'' patients.

+

These help in ''anulomana'' (elimination through the downward movement) of flatus, urine, feces and ''[[dosha]]s''. Being liquid and hot they also cause sweating. Being watery in nature they also alleviate thirst. Due to their nourishing property as a diet, they sustain the ''prana'' (vitality) and cause lightness of the body because of their laxative property. They bring down the ''jwara'' and are also wholesome for the ''jwara'' patients.

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

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</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]

+

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>

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</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]

+

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>

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</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]

+

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 ''[[dosha]]s''). [160-161]

</div>

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

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</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]

+

If, decoctions of astringent drugs are administered to the patient in ''taruna jwara'' (first stage of ''jwara'') stage, then the ''[[dosha]]s'' 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]

</div>

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

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</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.

+

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.

−

Ghee should not be given to ''jwara'' patient even after the tenth day, if the ''kapha dosha'' still predominates and if the signs and symptoms of well accomplished ''langhana'' have not appeared. In such case ''kashaya'' should be administered to the patient till the body becomes light.

+

Ghee should not be given to ''jwara'' patient even after the tenth day, if the ''[[kapha dosha]]'' still predominates and if the signs and symptoms of well accomplished ''[[langhana]]'' have not appeared. In such case ''kashaya'' should be administered to the patient till the body becomes light.

−

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]

+

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 ''[[dosha]]s'' and promotes the strength of the body. [164-167]

</div>

=== Indication of milk ===

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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 ''[[vata]]'' and ''[[pitta dosha]]'' predominate the patient is suffering from ''jwara''

−

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

+

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

</div>

−

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

+

=== Indication of ''[[virechana]]'' ===

Line 2,660: Line 2,662:

</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]

+

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) ===

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</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.)

+

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.)

−

''Niruha basti'' administered when the dosha are in ''paripakva'' stage immediately promotes the strength and the power of digestion, alleviates fever and causes happiness and brings relish for food.

+

''Niruha [[basti]]'' administered when the [[dosha]] are in ''paripakva'' stage immediately promotes the strength and the power of digestion, alleviates fever and causes happiness and brings relish for food.

−

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]

+

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]

</div>

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

Line 2,726: Line 2,728:

</div></div>

−

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

+

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 ''[[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]

Line 3,047: Line 3,049:

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]

+

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 ''[[dosha]]s'' should give the meat soup of these animals also at apropriate time.[190-194]

</div>

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

Line 3,066: Line 3,068:

</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]

+

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

</div>

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

Line 3,091: Line 3,093:

</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~~''.

+

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 ''[[dosha]]s''.

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

Line 3,139: Line 3,141:

*The decoction of ''patha'' and ''ushira'' along with ''udichya''.

−

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]

+

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 ''[[dosha]]s''; alleviate thirst, anorexia and cure ''mukha vairasya'' (bad taste of the mouth). [197-199]

</div>

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

Line 3,284: Line 3,286:

</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 either ''jati, amalaka'' and ''musta'' or that of ''dhanavayavasakam'' along with ''guda'' (jaggery) should be given to the patient suffering from ''jwara'' where the ''[[dosha]]s'' are in ''vibaddha'' state (adhered to ''[[dhatu]]s'').

−

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]

+

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

</div>

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

Line 3,404: Line 3,406:

</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]

+

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 3,628: Line 3,630:

</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]].

+

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

−

''Vamana'' performed by hot water and ''madana'' mixed with either ''pippali, kalinga'' or ''madhuka'' alleviates ''jwara''.

+

''[[Vamana]]'' performed by hot water and ''madana'' mixed with either ''pippali, kalinga'' or ''madhuka'' alleviates ''jwara''.

Emetic therapy given by administering water mixed with honey, sugar cane juice, water mixed with rock salt, alcoholic drinks and ''tarpaṇa'' (roasted corn flour eaten mixed with water) is also useful in ''jwara''.

Line 3,732: Line 3,734:

Milk boiled by adding water four times cures ''jwara''.

−

''Dharoshna'' milk (freshly milked from the cow, when its still hot) immediately cures ''jwara'' caused by the aggravation of ''vata'' and ''pitta''.

+

''Dharoshna'' milk (freshly milked from the cow, when its still hot) immediately cures ''jwara'' caused by the aggravation of ''[[vata]]'' and ''[[pitta]]''.

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]

Line 3,909: Line 3,911:

</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''.

+

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

−

''Patola, arishtha'' leaves, ''ushira, chaturangula, hribera, rohini, tikta, shvadanshtrā, madana, sthira'' and ''bala'' – these drugs should be boiled in milk by adding water which should be taken in equal the quantity of milk. This should be boiled till the amount equal to that of milk is left. To this mixture honey and ''ghrita'' should be added along with the ''kalka'' of ''madana, musta, pippali, madhuka'' and ''vatsaka''. This portion should be administered in the form of enema for the cure ''jwara''. When the ''margas'' (channels) are clean, the ''~~doshas~~'' are eliminated and the ''~~dhatus~~'' are refreshed. Then the pain in the body disappears and the body becomes light and instantaneously free from fever.

+

''Patola, arishtha'' leaves, ''ushira, chaturangula, hribera, rohini, tikta, shvadanshtrā, madana, sthira'' and ''bala'' – these drugs should be boiled in milk by adding water which should be taken in equal the quantity of milk. This should be boiled till the amount equal to that of milk is left. To this mixture honey and ''ghrita'' should be added along with the ''kalka'' of ''madana, musta, pippali, madhuka'' and ''vatsaka''. This portion should be administered in the form of enema for the cure ''jwara''. When the ''margas'' (channels) are clean, the ''[[dosha]]s'' are eliminated and the ''[[dhatu]]s'' are refreshed. Then the pain in the body disappears and the body becomes light and instantaneously free from fever.

A decoction prepared from ''aragvadha, ushira,'' fruits of ''madana, shalaparni, prishniparni, mashaparni'' and ''mudgaparni'', mixed with the paste of ''priyangu, madana, musta, shatavha'' and ''madhuyashti'' should be used as an enema, for the cure of ''jwara''.

Line 3,919: Line 3,921:

A small quantity of rock salt should also be added to this decoction along with honey and ''ghrita'' and used as ''niruha'' type of medicated enema for the alleviation of ''jwara'' as it promotes strength, sweating and taste appreciation.

−

A medicated ''ghrita'' prepared from the paste of ''jeevanti, madhuka, meda, pippali, madana, vacha, riddhi, rasna, bala, vishva, shatapushpa'' and ''shatavari,'' boiled with milk, water, ''ghrita'' and oil, should be used as ''anuvasana basti'' for the treatment of ''jwara''.

+

A medicated ''ghrita'' prepared from the paste of ''jeevanti, madhuka, meda, pippali, madana, vacha, riddhi, rasna, bala, vishva, shatapushpa'' and ''shatavari,'' boiled with milk, water, ''ghrita'' and oil, should be used as ''anuvasana [[basti]]'' for the treatment of ''jwara''.

−

The ''sneha'' (''ghrita'' and oil) boiled with ''paṭola, pichumarda, guduchi, madhuka'' and ''madana'' should also be used as ''anuvasana basti'' for the treatment of ''jwara''.

+

The ''sneha'' (''ghrita'' and oil) boiled with ''paṭola, pichumarda, guduchi, madhuka'' and ''madana'' should also be used as ''anuvasana [[basti]]'' for the treatment of ''jwara''.

−

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]

+

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]

</div>

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

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</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''.

+

Drugs for ''shirovirechana'' therapy (module of taking out the ''[[dosha]]s'' 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]

Line 4,248: Line 4,250:

''Sheeta 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 ''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]

+

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 ''[[dosha]]s'') and the ''bala'' of each ''[[dosha]]''. [268-271]

</div>

−

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

+

===Contra-indications of ''[[langhana]]'' ===

Line 4,267: Line 4,269:

</div></div>

−

''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]

+

''[[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]

</div>

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

Line 4,400: Line 4,402:

</div></div>

−

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.

+

The aggravated ''[[dosha]]s'' 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.

−

The ''~~malās~~'' of the seven ''~~dhatus~~'' get metabolized in seven days. Therefore, generally on the eighth day the ''jwara'' becomes ''nirama'' (free from the accumulated metabolic waste product).

+

The ''[[mala]]s'' of the seven ''[[dhatu]]s'' get metabolized in seven days. Therefore, generally on the eighth day the ''jwara'' becomes ''nirama'' (free from the accumulated metabolic waste product).

−

If a person takes heavy food in the stage when the ''~~doshas~~'' 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 a person takes heavy food in the stage when the ''[[dosha]]s'' 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 ''[[vata]]''.

−

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]

+

If the ''jwara'' is caused by ''[[vata]]'' and is not associated with the other two ''[[dosha]]s'' 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]

</div>

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

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</div></div>

−

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

+

''[[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

−

*When ''jwara'' is produced by the aggravated ''kapha dosha''

+

*When ''jwara'' is produced by the aggravated ''[[kapha dosha]]''

−

*When both the ''kapha'' and the ''pitta dosha'' are aggravated together

+

*When both the ''[[kapha]]'' and the ''[[pitta dosha]]'' are aggravated together

−

''Vamana, virechana'' and ''~~bastī~~'' therapies should be administered to cure the ''jwara'' caused by the aggravated ''~~vāta~~, pitta'' and ''kapha dosha'' respectively.

+

''[[Vamana]], [[virechana]]'' and ''[[basti]]'' therapies should be administered to cure the ''jwara'' caused by the aggravated ''[[vata]], [[pitta]]'' and ''[[kapha dosha]]'' respectively.

−

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 ''~~doshas~~'' should be ascertained and the treatment planned according to the line of treatment and drugs prescribed for that ''dosha''.

+

In the case of ''saṁsṛṡṭra'' and ''sannīpātaja'' (in case of combination of two or all the three ''[[dosha]]s'') type of ''jwara'', the ''tara'', ''tama'' and ''sama'' (lesser, greater or equal) status of the vitiated ''[[dosha]]s'' 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 ''~~doshas~~'' in order, beginning with the site of ''kapha''.[283-287]

+

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

</div>

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

Line 4,501: Line 4,503:

</div></div>

−

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]

+

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]

</div>

=== Indications of blood letting ===

Line 4,539: Line 4,541:

</div></div>

−

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]

+

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]

</div>

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

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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]

</div>

−

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

+

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

Line 4,613: Line 4,615:

</div></div>

−

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]

+

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]

</div>

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

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

*The meat of chicken, patridge and peacock are used as food

−

*Intake of medicated ghee called as ''shatapala; abhaya; triphala'' decoction; ''guduchi'' juice; preparation of ''nīlinī, ajagandhā, trivrita'' and ''kaṭurohiṇī'' during the onset of fever. These things should be administered to the patient appropriately, after the patient is given ''snehana'' and ''swedana'' therapies (oleation and sudation).

+

*Intake of medicated ghee called as ''shatapala; abhaya; triphala'' decoction; ''guduchi'' juice; preparation of ''nīlinī, ajagandhā, trivrita'' and ''kaṭurohiṇī'' during the onset of fever. These things should be administered to the patient appropriately, after the patient is given ''[[snehana]]'' and ''[[swedana]]'' therapies (oleation and sudation).

*Emesis after the administration of ghee in large quantity

*Emesis after taking large quantity of food and drinks

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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]

</div>

−

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

+

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

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</div></div>

−

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

+

When the ''[[dosha]]s'' causing ''jwara'' are located in –

−

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

+

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

−

*the ''rakta ~~dhātu~~'', then ''seka'' and ''pradeha'' (pouring of hot medicated liquids and ointment application) should be done.

+

*the ''[[rakta dhatu]]'', then ''seka'' and ''pradeha'' (pouring of hot medicated liquids and ointment application) should be done.

−

*in the ''~~mānsa~~'' and the ''~~medas~~ virecana'' and ''upavāsa'' should be done.

+

*in the ''[[mamsa dhatu]]'' and the ''[[meda dhatu]] [[virecana]]'' and ''upavāsa'' should be done.

−

*in the ''~~asthī~~'' and ''~~majjā dhātūs~~, nirūha'' and ''anuvāsana ~~bastīs~~'' should be given. [315-317]

+

*in the ''[[asthi dhatu]]'' and ''[[majja dhatu]]s, nirūha'' and ''anuvāsana [[basti]]s'' should be given. [315-317]

</div>

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

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</div></div>

−

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.

+

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 ''[[dosha]]s'' with sound.

−

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 remission of ''jwara'' occurs with difficulty (''daruna moksha'').

+

If a severe condition of ''jwara'' with excessively aggravated ''[[dosha]]s'' and recent onset, is treated with appropriate therapy, then ''[[dosha]] paka'' occurs. Because of this, the sudden remission 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]

+

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

</div>

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

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</div></div>

−

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.

+

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 ''[[dosha]]s'' 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.

−

Sometimes, ''~~doshas~~'' undergo ''paripāka'' (metabolic transformation) in the ''~~dhātūs~~'' and gradually the fever subsides. But, their harmful effects continue as a result of which the patient suffers from ''dīnata'' (uneasiness), ''shvayathu'' (edema), ''glani'' (lassitude), ''panduta'' (pallor or anemia), loss of appetite, itching, urticaria, pimples and suppression of the power of digestion.

+

Sometimes, ''[[dosha]]s'' undergo ''paripāka'' (metabolic transformation) in the ''[[dhatu]]s'' and gradually the fever subsides. But, their harmful effects continue as a result of which the patient suffers from ''dīnata'' (uneasiness), ''shvayathu'' (edema), ''glani'' (lassitude), ''panduta'' (pallor or anemia), loss of appetite, itching, urticaria, pimples and suppression of the power of digestion.

−

Similarly, other diseases which are already cured reappear in the individual due to the non – elimination of the ''~~doshas~~'' completely, even by resorting to little unwholesome regime after the cure of the disease.

+

Similarly, other diseases which are already cured reappear in the individual due to the non – elimination of the ''[[dosha]]s'' completely, even by resorting to little unwholesome regime after the cure of the disease.

−

Therefore, the ''~~doshas~~'' should be eliminated from the body either by elimination or alleviation therapies depending upon the stage and strength of the ''~~doshas~~'', 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.

+

Therefore, the ''[[dosha]]s'' should be eliminated from the body either by elimination or alleviation therapies depending upon the stage and strength of the ''[[dosha]]s'', 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]

+

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]

</div>

=== Guidelines for management ===

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== Tattva Vimarsha (Fundamental Principles) ==

−

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

+

*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'').

*In order to know a disease, the diagnosis of ''sharira'' (physical) and ''manasa'' (mental); ''saumya'' (predominated by cold) and ''agneya'' (predominated by heat); ''antarvega'' (internal) and ''bahirvega'' (external); ''prakrita'' (according to seasons) and ''vaikrita'' (unseasonal); ''sadhya''(curable) and ''asadhya'' (incurable) should be made and treated accordingly.

*The psychic involvement in a disease shall be assessed on the basis of ''vaichitya'' (mental instability), ''arati'' (disliking for everything) and ''glani'' (feeling of weakness in the body).

−

*''Dosha'' dominance can be assessed by the desire to take cold or hot things. In ''vata-pitta'' dominant diseases, there is desire for cold things and in ''vata-kapha'' dominant diseases, there is desire for hot things.

+

*''[[Dosha]]'' dominance can be assessed by the desire to take cold or hot things. In ''[[vata]]-[[pitta]]'' dominant diseases, there is desire for cold things and in ''[[vata]]-[[kapha]]'' dominant diseases, there is desire for hot things.

−

*Seasonal variations in temperature, environment can adversely affect the ''dosha'' balance leading to diseases originated from naturally vitiated ''dosha''.

+

*Seasonal variations in temperature, environment can adversely affect the ''[[dosha]]'' balance leading to diseases originated from naturally vitiated ''[[dosha]]''.

−

*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 subsides, then disease occurs.

+

*As a seed remains dormant in the soil and germinates at a favorable time, similarly the ''[[dosha]]s'' remain in dormant condition in the ''dhatu'' and get aggravated at a favorable time. These ''[[dosha]]'' gain strength at an appropriate time and when the power of the inhibiting (disease preventing) factors subsides, then disease occurs.

−

*In the ''abhighataja jwara'', caused by any injury, vitiated ''vata'' affects predominantly ''rakta'' (blood) to resulting in ''jwara'' with discomfort, swelling, discoloration and pain. This resembles with inflammation.

+

*In the ''abhighataja jwara'', caused by any injury, vitiated ''[[vata]]'' affects predominantly ''[[rakta]]'' (blood) to resulting in ''jwara'' with discomfort, swelling, discoloration and pain. This resembles with inflammation.

*The exogenous ''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).

−

*The processes of vitiated ''dosha'' spread all over body after combining with the ''rasa'' (first ''dhatu'' of nutrition), its effect of displacement of ''agni'' (hampering metabolism), obstruction of transport channels specifically sweat pores leading to increase in internal heat are important milestones in pathogenesis of ''jwara''.

+

*The processes of vitiated ''[[dosha]]'' spread all over body after combining with the ''[[rasa]]'' (first ''[[dhatu]]'' of nutrition), its effect of displacement of ''agni'' (hampering metabolism), obstruction of transport channels specifically sweat pores leading to increase in internal heat are important milestones in pathogenesis of ''jwara''.

−

*''Langhana'' (fasting) reduces the aggravated ''dosha'', stimulates the ''agni'', and leads to lightness and restoration of appetite with alleviation of ''jwara'' .

+

*''[[Langhana]]'' (fasting) reduces the aggravated ''[[dosha]]'', stimulates the ''agni'', and leads to lightness and restoration of appetite with alleviation of ''jwara'' .

−

*''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.

+

*''[[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.

−

*Any treatment shall always be performed after proper assessment of nature and state of ''dosha''. Otherwise it leads to complications and adverse effects.

+

*Any treatment shall always be performed after proper assessment of nature and state of ''[[dosha]]''. Otherwise it leads to complications and adverse effects.

−

*The purification treatments are done only in a state of ''utklishta dosha'' (on the verge of being expelled out). If the ''dosha'' are excessively vitiated, but not in ''utklishta'', then pre-purification treatments like ''deepana, pachana, snehana'' are performed to bring the ''dosha'' to ''utlishta'' state.

+

*The purification treatments are done only in a state of ''utklishta [[dosha]]'' (on the verge of being expelled out). If the ''[[dosha]]'' are excessively vitiated, but not in ''utklishta'', then pre-purification treatments like ''[[deepana]], [[pachana]], [[snehana]]'' are performed to bring the ''[[dosha]]'' to ''utlishta'' state.

−

*''Langhana'' (fasting), ''swedana'' (fomentation to remove obstruction in sweat pores), ''kala'' (waiting period of eight days), ''yavagu'' (medicated gruels) and ''tikta rasa'' drugs (drugs having bitter taste) and all digestive enhancers of ''avipakva dosha'' (untransformed) are prescribed in the initial stage of ''jwara''.

+

*''[[Langhana]]'' (fasting), ''[[swedana]]'' (fomentation to remove obstruction in sweat pores), ''kala'' (waiting period of eight days), ''yavagu'' (medicated gruels) and ''tikta rasa'' drugs (drugs having bitter taste) and all digestive enhancers of ''avipakva [[dosha]]'' (untransformed) are prescribed in the initial stage of ''jwara''.

−

*When ''vayu'' is predominantly aggravated in ''jwara'', then patient should be treated by the administration of ''ghee, niruha'' and ''anuvasana ~~bastis~~'' (medicated enemas), unctuous and hot diet and drinks.

+

*When ''vayu'' is predominantly aggravated in ''jwara'', then patient should be treated by the administration of ''ghee, niruha'' and ''anuvasana [[basti]]s'' (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.

+

*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, the patient should be administered emetic therapy, ''pachana'' (therapy which promotes the digestion and metabolism), non-unctuous diet and drinks, fasting and hot decoctions are useful.

+

*In state of ''[[kapha]]'' predominance, the patient should be administered emetic therapy, ''[[pachana]]'' (therapy which promotes the digestion and metabolism), non-unctuous diet and drinks, fasting and hot decoctions are useful.

−

*When the ''~~doshas~~'' causing ''jwara'' are located in the ''rasa dhatu'', then ''vamana'' and ''upavasa'' (emesis and fasting) should be done; in case of location in the ''rakta dhatu, seka'' and ''pradeha'' (pouring of hot medicated liquids and ointment application) should be done; in case of ''mamsa'' and the ''~~medas~~ virechana'' and ''upavasa'' should be done; in the ''asthi'' and ''majja ~~dhatus~~, niruha'' and ''anuvasana ~~bastis~~'' should be given.

+

*When the ''[[dosha]]s'' causing ''jwara'' are located in the ''[[rasa dhatu]]'', then ''[[vamana]]'' and ''[[upavasa]]'' (emesis and fasting) should be done; in case of location in the ''[[rakta dhatu]], seka'' and ''pradeha'' (pouring of hot medicated liquids and ointment application) should be done; in case of ''[[mamsa dhatu]]'' and the ''[[meda dhatu]] [[virechana]]'' and ''upavasa'' should be done; in the ''[[asthi dhatu]]'' and ''[[majja dhatu]]s, niruha'' and ''anuvasana [[basti]]s'' should be given.

*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.

*''Jwara'' caused by abhighata (external injury) gets cured by the intake and massage of ghee, blood-letting, intake of rice with wholesome meat soup.

*Mental factors like kama (passion), shoka (grief) and bhaya (fear) gets cured by the ashvasana (assurance), ishṭa labha (providing the desired object), alleviation of vayu and harshana (bringing excitement or pleasure).

−

*Krodha (anger) subsides by providing kamya artha (desired object), manojna artha (pleasing object), therapies for the alleviation of pitta and sadvakya (correct advice).

+

*Krodha (anger) subsides by providing kamya artha (desired object), manojna artha (pleasing object), therapies for the alleviation of [[pitta]] and sadvakya (correct advice).

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

*If a patient gets jwara just by thinking about it, then his mind should be diverted to desirable, different and surprising incidents (vishaya).

*For prevention of re-occurrence of jwara and during its treatment, one should avoid the following: intake of food and drinks which are vidahi (causing burning sensation), guru (heavy), asatmya (unwholesome) and viruddha (mutually contradictory); sexual intercourse, excessive exhaustion, bath, excessive walking exercise, should be avoided by the person who has become free from jwara till he regains strength.

−

*The remission of jwara depends upon strength of dosha. In acute stage, the remission occurs with difficulty because of severity of dosha. In chronic stage, the remission occurs without difficulty due to mild strength of dosha.

+

*The remission of jwara depends upon strength of [[dosha]]. In acute stage, the remission occurs with difficulty because of severity of [[dosha]]. In chronic stage, the remission occurs without difficulty due to mild strength of [[dosha]].

*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.

</div>

+

== Vidhi Vimarsha (Applied Inferences) ==

+

The clinical applications of jwara and different types of fevers are described in details in a separate article on [[Jwara]].

=== Related Chapters ===

−

*[[Jwara Nidana]]

+

*[[Jwara Nidana]] [[Jwara]]

+

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