Charaka – Jwara Chikitsa 3rd Chapter

The third chapter of Charaka Chikitsasthana is called Jwara Chikitsa. It deals with management of different types of fever. Jwara in general terms can be translated as fever.We shall now explore the chapter on the treatment of Jwara (different types of fever). Thus said Lord Atreya [1 2]

Agnivesha’s approach to Punarvasu

Punarvasu, who is free from 3 types of Jwaras (miseries) was sitting in a lonely place and had absolute tranquility of mind. Agnivesha, with folded hands approached him with his queries about Jwara [3]

Agnivesha’s Query

Oh! Lord! You have already stated earlier (in Nidana Sthana 1:6) that “Jwara is the most painful among the diseases. It afflicts the body, the senses and the mind. It is exceedingly powerful. This enemy of human beings is invariably associated with dissolution birth and death. (It is told that one gets fever during birth and death). Therefore kindly explain the following points for the benefit of the living being:

Prakruti or nature of the disease
Pravrtti or origin of the disease
Prabhava or the manifestations of the disease
Karana or causative factors
Purva Rupa or premonitory signs and symptoms
Adhisthana or place of manifestation
Bala Kala or its power and the time of its manifestation
Atma Laksana or signs and symptoms which are invariably associated with this diseases
Details of classification
Signs and symptoms of each variety of this disease
Signs and symptoms of Ama Jwara i.e primary stage of the disease
Signs and symptoms of Jeerna Jwara or chronic disease
medicines for the treatment of the disease
Line of treatment
Sign and symptoms that are manifested when the fever is getting cured, or when it is being alleviated both separately
The duration for which the patient who has become free from Jwara should avoid certain regimens, and the reasons for that
The reason for the re-attack of the fever after it has subsided
The therapies administered in order to alleviate this re-attack of fever
After bearing the treatment of Agnivesha, the preceptor said: “All these will be explained in this chapter on the description of fever Oh affectionate one! Hear them in detail”. [4:2:10]

Synonyms of Jwara

The synonyms of Jwara are – Jwara (fever), Vikara (ailment), Roga (disease), Vyadhi (disease) and Atanka (fear inducing factor) [11]

Nature of Jwara

Factors which are responsible for the manifestation of Jwara, in brief are –
the 3 physical Doshas Vata, Pitta and Kapha
and 2 Doshas of the mind namely – Rajas and Tamas
Living beings do not get afflicted with Jwara without the involvement of these Doshas. [12]

Jwara features

Specific features of Jwara – Jwara Prakruti
Kshaya depletion of body tissues, weight loss,
Tamas entering into internal darkness
Papma manifestation of the sinful acts and
Mrutyu death

The specific feature of disease is:
Jwara is like Yama (God of death). Being afflicted of his own actions, the individual succumbs to death after suffering from fever. [13 14]

Origin of the disease – Jwara Pravrutti
The origin of Jwara is because of the attachment (Parigraha).
In the Nidana section, it has been described that Jwara is originated because of the ferocious wrath of Rudra. [14]

Fever origin mythology

Mythology about the origin of Jwara:
During the second age (Treta Yuga), Lord Shiva took a vow not to manifest wrath for 1,000 celestial years. During this time, the Asuras (demons), who indulged in creating obstruction to the penance of sages, made mischief. Daksha Prajapati was capable of combating their obstructions to the penance of this great soul (Shiva). But he did not make any effort in this direction. Again, in the Yajna (Homa), Daksha Prajapati did not offer a share to Maheshvara even though he was requested to do by the Gods. These are also the description of giving Ahuti (pouring of ghee in the sacrificial fire) for Shiva. These 2 rituals are necessary for proper accomplishment of the Yajna and for achieving the desired objectives. Daksha Prajapati, however, did not perform these 2 rituals during his Yajna.

Lord Shiva is endowed with the power to know everything by himself. When he completed the penance and got up, he realized the evasion of the duty by Daksha and became angry. He touched his third eye in his forehead, and from this third eye emanated the wrathful fire which burnt all those Asuras (demons). From this fire a child called Veerabhadra took birth. He was dazzling with the fire produced because of Shiva ;s anger. He pursues the mission of destroying the enemies and destroyed the Homa of Daksha prajapati. As a result of this, the Gods got afflicted with burning sensation and pain. The living beings all around became unconscious.

Thereafter, the Gods along with sages offered prayers to the Omnipotent and Omnipresent Lord Shiva by the help of Ahutis described in the Rig Veda. This alleviated the wrath of Lord Shiva and endowed Him with the compassionate as well as auspicious disposition.

When it was known that Lord Shiva has developed an auspicious disposition, Veerabhadra who was produced from the wrathful fire, who had 3 heads and 9 eyes, who had ash as his weapon, who had the flame of fire as his garland, who was wrathful and who had slender legs and stomach, approached Lord Shiva and inquired him about his future work.

Lord Shiva replied to that incarnation of his anger, “You will become Jwara in this world and afflict people at the time of birth and death and also afflict those who will resort to erratic regimens”. [15 25]

Jwara manifestations

Manifestations of Jwara – Jwara Prabhava

The special manifestations of Jwara:
Santapa temperature
Aruchi Anorexia
Trushna excessive thirst
Angamarda malaise, body ache with heaviness
Hrudi Vyatha pain in cardiac region

In the beginning of the birth and during death, it is manifested in the form of Tamas (entering into darkness).
Thus, the Prakruti (nature), Pravrutti (origin) and Prabhava (special manifestation) of Jwara are described. [26 27]

Etiological factors

Etiological factors of Jwara:

In the Nidana section, the etiological factors of each of the 8 types of Jwara are described separately. [27]

Premonitory signs and symptoms

Jwara Poorvaroopa
Alasyam Lethargy
Nayana aasre excessive lacrimation
Jrambhana yawning
Gauravam heaviness
Klama – Mental fatigue
Jwalana, Aatapa, Vayu and Ambu Bhakti Dwesha Uncertainty about liking and disliking for fire, sun, wind and water
Avipaka Indigestion
Vairasya Anorexia
Bala Hani Depletion in strength and complexion, and
Alpa Sheela Vikruti – Slight change in conduct [28 29]

Site of manifestation

Site of Manifestation of fever:
Jwara Adhishtana:
The entire body along with the mind
The strength and the time of manifestation of Jwara are already described in Nidana 1:21, 24 and 27. [30]

Classical features

Classical feature of fever:

Jwara Pratyatmaka Linga:
The signs and symptoms invariably associated with Jwara are
Santapa Deha Manasa The increase in the temperature of the body and mental unhappiness.
There is no living being which is not afflicted by Jwara [31]

Classification

Jwara Bheda – Classification:

Classification of fever:
Jwara is classified into 2 categories, each on the basis of the following criteria:

1. Sharira (Physical) and Manasa (mental)
2. Saumya (caused by cold) and Agneya (caused by heat).
3. Antarvega (internal) and Bahirvega (external)
4. Prakruta (natural, seasonal) and Vaikruta (Unseasonal) and
5. Sadhya (curable) and Asadhya (incurable).

Jwara is again classified into 5 categories depending upon the strength and weakness of Doshas and the time. These are
Satata, Santata, Anyedyuska, Trtiyaka and Chaturthaka.

Depending upon the Ashraya (site of manifestation) in the 7 Dhatus (basic tissue elements), Jwara is also classified into 7 categories. [32 35]

Signs and symptoms of each variety of Jwara:

The Sharira (Physical) type of Jwara first appears in the body and the Manasa (mental) type first appears in the mind.

The Manas Taapa – mental discomfort manifests as:
Vaichitya mental instability
Arati disliking for everything and
Glani feeling of weakness in the body
The Santapa of the Indriyas (sense organs) in indicated by their morbidity. [36 37]

The patient suffering from Jwara caused by:
Pitta desires cold things.
Vayu and Kapha desire hot things.
When, however, these Doshas get mixed up, both the types of symptoms are manifested. [37 38]

Vata Dosha is a Yogavahi
Vata is exceedingly Yogavahi (which accentuates the properties of others) in nature.
In combination, it produces both the types of effects.
For example, when combined with Tejas (fire), it produces burning sensation and when combined with Soma (water) it produces cooling effects. [38 39]

Antarvega, Bahirvega jwara

Antarvega and Bahirvega symptoms of Jwara:
The signs and symptoms of Antarvega (internal) type of Jwara:
Antardaha Burning sensation inside the body
Trishna Excessive thirst
Pralapa delirium, irrelevant talk
Shwasana dyspepsia, difficulty in breathing
Bhrama giddiness,
Sandhi asthi shoola pain in bones and joints
Asveda Absence of sweating
A-varchas non excretion of Doshas and feces

The signs and symptoms of Bahirvega (external) type of Jwara:
Excessive temperature in the exterior of the body, and less of thirst etc symptoms. This type of Jwara is easily curable. [39 41]

Prakruta jwara

Prakruta Jwara – seasonal fever:

Prakruta Jwara – seasonal fever:
The Jwara that manifests in Vasanta (spring season) and Sharat (autumn season), is called Prakruta (seasonal). It is easily curable.
Kapha which gets aggravated in winter gets excited during Vasanta (spring) season.
Pitta is hot in nature and it gets aggravated during Sharat (autumn) season.

Jwara during Varsha Rutu

Jwara during Varsha Rutu (Rainy season):
During rainy season the water, herbs and dishes become sour in Vipaka (taste that emerges after digestion). This results in the accumulation of Pitta. This accumulated Pitta gets excited or aggravated in autumn because of the exposure to hot Sun rays. This may immediately produce Jwara.

Kapha is the secondary associate in the manifestation of Jwara. Autumn is the Visarga Kala (time of elimination). Therefore, fasting (which is the first step for the treatment of Jwara) does not create any problem.

During Hemanta (first part of the winter season), the water, herbs and dishes become sweet in taste. This helps in the accumulation of Kapha. The Kapha gets aggravated in the subsequent spring season because of strong rays of the sun. Therefore, during Vasanta (spring), Kaphaja Jwara is manifested.
Spring season is a part of Adana Kala (time of absorption) and in any type of Jwara that is caused during this period, Vata and Pitta constitute its secondary associates. [42 47]
The wise should treat a patient suffering from Jwara keeping in view the strength or weakness of Doshas in the beginning, at the end and in the middle of Sharat (autumn) and Vasanta (spring) seasons. [47 48]

Vaikruta Jwara

Depending upon the nature of the season, seasonal (Prakruta) type of Jvara is described.

Generally the Jwara caused by Vata Dosha is difficult to cure. The following types of Jwara are to be treated as Vaikruta:

• Vatika Jwara irrespective of its season of occurrence.
• Paittika Jwara if it occurs during seasons other than autumn.
• Kapha Jwara if it occurs during seasons other than spring.

The causative factors of different types of Jwara are described in the Nidana section. [48 49]

Sadhya Asadhya Jwara

Sadhya Jwara – Easily curable fever:
In a person with strong physique, if Jwara occurs by the vitiation of fewer amounts (number) of Doshas and if there is no complication; then it is easily curable. [50]

Incurable type of Jwara – Asadhya

The Jwara having the following characteristics leads to death, which:
Caused by strong etiological factors
Associated with many signs and symptoms and
Destroys the sense organs immediately

Bad prognosis

Acute fever (Teekshna Jwara) associated with
Pralapa delirium,
Bhrama Giddiness and
Shwasa difficulty in breathing, asthma causes death of the patient on the seventh, tenth or twelfth days. [51 52]

If deep seated (Gambhira) and strong fever occurs in a weak and in an emaciated patient, and continues for several nights (Dairgha Ratrika), then it is incurable. In such diseases; the hairs of the head fall apart to produce a straight line (Kesha Semanta Krut) [52 53]

Vishama Jwara

This type of fever is recurrent in nature with certain time gap in between.
Visham Jwar is of 5 types.
Santataka Jwara – Affects Rasavaha Srotas. either gets cured or kills the patient on 12^th, 10^th or 7th day.
Satata Jwara – Affects Rakta Dhatu, In a day and night, Satataka Jwara occurs twice
Anyedyushka Jwara – Affects Rakta dhatu and Medovaha Srotas. Jwara occurs once per day.
Truteeyaka – Occurs on every third day (on alternate days). Asthi Dhatu and Mamsavaha srotas are involved.
Chaturtaka – occurs with a gap of two days. Afflicts Majja Dhatu and Medovaha Srotas.

Santataka Jwara

The imbalanced spread all across the body through Rasavaha Srotas causing stiffness. Such a fever is called Santata Jwara. It manifests its symptoms very quickly and either gets cured or kills the patient on 12^th, 10^th or 7th day. It is extremely difficult to tolerate this type of fever.

If the Doshas involved in Santata type of Jwara is similar in property to the season (Kala), Dhatus (Dushya) and physical constitution (Prakruti), then it is Asadhya (incurable).
If the Dhatus and waste products (urine, stool and flatus) are purified, then on 7^th, 10^th, or 12^th days the fever gets subsided. However, if Dhatus and Malas are not purified then fever kills the patient on those days. The death of the patient occurs even if these Dhatus are partially purified.

The Santata Jwara is thus located on 12 factors namely, 7 Dhatus, 3 Doshas, Urine and stool. Even if the fever subsides on 12^th day etc. the symptoms of Jwara may become latent. It may continue for a longer period and cure of this disease is extremely difficult. Therefore, the physician should first administered Apatarpana (fasting) treatment, followed by other treatments for fever.[53 61]

Satataka Jwara

Fever that occurs twice in a day
In Satataka Jwara, Dosha is mostly located in the Rakta Dhatu. It can be treated with success.
It gets aggravated and subsided depending upon the nature of the time.
In a day and night, Satataka Jwara occurs twice. [61 62]

Anyeduska, Truteeyaka and Chaturthaka Jwara:

Anyedyuska Jwara

Fever that occurs every day
Occurrence: Due to the support of the strength of any one from among the Kala (time), Prakruti (physical constitution) and Dushya (Dhatus). It occurs every day. It affects Medovaha Sira (fat channels) Here Rakta is vitiated.

Trtiyaka Jwara

Fever that occurs on alternate days
It occurs when Doshas afflict Asthi Dhatu (bone tissue). In this type of fever, Mamsavaha Srotas is also involved.

Chaturthaka Jwara

Fever that repeatedly occurs after every 2 days. Here Doshas afflict Majja Dhatu (marrow) and Medovaha Srotas (Fat channels).

According to some scholars different types of Jwara viz, Anyedyuska, Trtiyaka and Chaturthaka are manifested because of the affliction of alternate Dhatu by the Dosha. [63 67]

Why the fever spikes in Trutiyaka and Chaturtaka Jwara?
As a seed in the soil waits for the right time to germinate, similarly, imbalanced Dosha remain inactive in the Dhatus till suitable time. When the Dosha gains strength in time and when the power of the inhibiting factors (immunity) is subsided, then Trutiyaka and Chaturthaka types of Jwara occur. [68 69]

Explanation for day gaps in Trutiyaka and Chaturthaka Jwara:
The Doshas, after manifesting their aggravated signs and symptoms, lose their strength and get located in their respective places. At the appropriate time, they again get aggravated to afflict the person with fever. [70]

Trutiyaka type of Jwara is of three types as follows:
When manifested by the aggravation of

Trikagrahi – Kapha and Pitta, it afflicts the Trika (lumbo-sacral joint)
Prushtagrahi – Vata and Kapha, it afflicts the Prushta (back)
Shirograhi – Vata and Pitta, it afflicts the Shiras (head)

Similarly, Chaturthaka Jwara is of 2 types as follows, when manifested by the vitiation of-
Kapha afflicts calf region in the beginning.
Vata afflicts the head in the beginning. [71 72]

Another variety of Vishama Jwara (irregular or intermittent fever) is called Chaturthaka Viparayaya.

Each of the 3 Doshas viz. Vata, Pitta and Kapha cause this disease by afflicting 2 Dhatus viz., Asthi (bone) and Majja (bone marrow) [73]

Vishama Jwara causative factors

Causative factor for vishama jwara-
The 5 types of Jwara are caused by Sannipata (Simultaneous vitiation of all the 3 Doshas). However, the Dosha which is predominant among 3 is considered the causative factor. [74]

Manifestation of Jwara in a particular time because of the following factors:
Rutu – season
Ahoratra Dosha – variation of Doshas in day and night
Manasa balaabalat – mind’s strength or weakness

Dhatugata Jwara

Dhatugata Jwara: Features of Jwara when it afflicts individual Dhatus:

Rasa Dhatu Gata Jwara

Gurutva – heaviness,
Dainya – miserable feeling, being humbled by the effect of disease
Udvega – restlessness
Sadana – malaise, lack of strength
Chardi – Vomiting
Arochaka – anorexia
Bahistapa – warm body and extremities, increase in external body temperature
Angamarda – bodyache
Vijrumbhana – yawning

Rakta Dhatugata Jwara

Signs and symptoms manifested when the vitiated Doshas causing Jwara are located in the Rakta Dhatu (hemoglobin fraction of blood):
Rakta Ushna – excess hotness of blood
Pidaka Pimples
Trushna Thirst
Sa Rakta Sthivana Frequent spitting of blood – hemoptysis
Daha Burning sensation
Raga redness
Bhrama Giddiness
Mada Intoxication and
Pralapa Irrelevant talk

Mamsagata Jwara

Signs and symptoms manifested when the vitiated Doshas causing Jwara are located in the Mamsa Dhatu (muscle tissue):
Antar daha Burning sensation inside the body (in internal organs)
Trushna Thirst
Sammoha Unconsciousness
Glani tiredness
Srushta Vitkata Diarrhea
Daurgandhyam Foul smell and strong movement of the limbs and the body
Gatra Vikshepa – body shivering

Medo dhatugata Jwara

Signs and symptoms manifested when the vitiated Doshas causing Jwara are located in the Medo Dhatu (fat tissue):
Teevra sweda Excessive sweating
Pipasa Thirst
Pralapa Delirium
Vamana Frequent vomiting
Swa gandhasy?sahatva? Inability to tolerate the smell of ones own body
Glani lassitude, debility
Arochaka Anorexia

Asthidhatugata Jwara

Signs and symptoms manifested when the vitiated Doshas causing Jwara are located in the Asthi Dhatu (bone tissue):
Vireka and Vamana Both diarrhea and vomiting
Asthi bheda Pain in the bones
Prakujanam Production of Kujana (cooing) sound
Gatra Vikshepa Strong movement of the body and its limbs
Shwasa – difficulty in breathing

Majja Dhatugata Jwara

Signs and symptoms manifested when the vitiated Doshas causing Jwara are located in the Majja Dhatu (bone marrow):
Hikka- Hiccup
Shwasa- Asthma, difficulty in breathing
Kasa- cough
Tama darshana- Frequently entering into the darkness, blinding,
Marma cheda- Pain in vital organs
Bahir shaityam- Cold extremities
Antardaha -Internal burning sensation

Shukradhatugata Jwara

Signs and symptoms manifested when the vitiated Doshas causing Jwara are located in the Shukra Dhatu (semen including sperm & ovum):
Shukra Moksham Ejaculation and
Shukra Vinasham Destruction of Shukra (semen) resulting in the extinction of life along with Vayu, Agni and Soma of the subtle body (Sookshma Sharira)

Curability of Dhatu Jwara (fever afflicting body tissues):
Rasa Rakta, Mamsa and Medas are Sadhya (curable)
Asthi and Majja are Kasta sadhya (difficult to cure)
Shukra is Asadhya (incurable)

Jwara based on Doshas

Eight types of Jwara based on Dosha:
Based on Dosha involvement, there are eight types of fever. Viz:
Vataja, Pittaja, Kaphaja,
Vata-Pittaja, Vata – Kaphaja, Pitta-Kaphaja
Sannipataja – Vata, Pitta and Kapha – all the three are involved.
Agantuja – fever due to external factors such as injury
Among these eight types of fever, Vataja, Pittaja, and Kaphaja fevers (caused by individual Doshas) are explained in detail in Jwara Nidana Chapter). The fever caused due to combination of Doshas is explained here –

Vata-Pittaja Jwara

Fever that occurs due to vitiation of Vata and Pitta Dosha exhibits following symptoms:
Shiro ruk -Headache
Parvanam bheda- breaking pain in fingers and toes
Daha- burning sensation
Romanam Praharshanam- horripilation
Kanthasya shosho -dryness of throat
Aruchi- anorexia
Swapna nasha -sleeplessness
Ati Vak – excessive talk and
Vijrumbha -Yawning

Vata Kaphatmaka Jwara

The signs and symptoms of Jwara caused by the vitiation of vata and kapha:
Sheeta -Feeling of cold
Gauravam -heaviness
Tandra- drowsiness
Staimityam -timidity, stiffness, as if covered by a wet cloth
Parva ruk -Pain in the fingers and toes
Shiro graha -rigidity of head, stiffness
Pratishaayaa-rhinitis,running nose
Kasa- cough
Asweda -absence of sweating and
Madhyavega Santapa -moderate rise in temperature

Kapha Pittaja Jwara

The signs and symptoms of the Jwara caused by the vitiation of Kapha and Pitta:
Muhurd?ho muhu? shitam Frequent feeling of burning sensation and cold
Sveda stambha Muhurmuhu? repeated episodes of sweating and no-sweating
moha- unconsciousness
Kasa- cough
Aruchi -anorexia
Trushna -thirst
Shle?ma pitta pravartanam elimination of phlegm and bile,
Lipta tikt?sya coated tongue and bitterness in the mouth
Tandra drowsiness

Thus different type of fever (Jwara) caused by the simultaneous vitiation of 2 Doshas (Dvandvaja) are described {84 89}

Sannipata Jwara

Due to imbalance of all the three Doshas:

Based on individual Dosha strength, Sannipataja Jwara is of 13 types.

Manda Kapha Jwara:
Sannipata Jwara – all 3 Doshas are involved, but Kapha Dosha is mild in imbalance. Symptoms are –
Bhrama- Giddiness
Pipasa- thirst,
Daha- burning sensation,
Gaurava- heaviness,
Shiras ati ruk- excessive headache

Manda Pitta Sannipata Jwara:

Sannipata Jwara in which vitiation of both Vayu and Kapha predominates over the vitiation of Pitta:
Shaitya? Coldness
Kasa- cough
Aruchi -anorexia
Tandra- drowsiness
Pipasa -thirst
Daha- burning sensation
Vyatha -pain

Manda Vata Sannipata Jwara:
The signs and symptoms of sannipata Jwara in which the vitiation of Pitta and Kapha predominates over the vitiation of Vata:
Chardi- vomiting
Shaityam -coldness
Muhur daha- frequent burning sensation
Trishna -thirst
Moha- unconsciousness and
Asthi vedana -pain in the bones

Vatolbana Sannipata Jwara – When Vata is dominant than Pitta and Kapha:
Sandhishoola- joint pain
Asthishoola- bone pain
Shiroshoola -headache
Pralapa- irrelevant talk
Gaurava- heaviness
Bhrama – dizziness, psychosis
Trushna -Excessive thirst
Kanthashosha- dry throat
Asyashosha -dry mouth

When Pitta dominates other Doshas in Sannipata Jwara: Pittolbana Sannipata Jwara:
Raktavit- blood in stools
Raktamootrata -blood in urine
Daha – Burning sensation
Sveda -excess sweating
Trut excess thirst
Balakshaya depleted strength and immunity
Murcha unconsciousness, fainting

When Kapha dominates other Doshas in Sannipata Jwara: Kapholbana Sannipata Jwara
Alasya laziness, lethargy
Aruchi – Anorexia, lack of interest in food
Hrullasa -nausea
Daha – Burning sensation
Vami- vomiting
Arati -lack of interest
Bhrama – dizziness, psychosis
Tandra- drowsiness
Kasa – cold, cough

Heena Vata Madhya Pitta Shleshma Adhika:
In Sannipata Jwara, where Vata is mild, Pitta is moderately dominant and Kapha is very dominant, it produces below symptoms:
Pratishyaya Running nose
Chardi vomiting
Alasya – laziness, lethargy
Tandra – drowsiness, weakness in sense organs
Aruchi – Anorexia, lack of interest in food
Agnimardava -weak digestion strength

Heena Vata, Madhya Kapha Pitta Adhika Sannipata Jwara:
In Sannipata Jwara, where, Vata is mildly dominant, Kapha is moderate and Pitta is highly dominant, it produces below symptoms.

Haridramutra – Excessive yellow colored urine
Haridranetra – Yellow sclera (eyes)
Daha – Burning sensation
Trushna Excessive thirst
Bhrama – dizziness, psychosis
Aruchi – Anorexia, lack of interest in food

Heenapitta Madhyakapha Maruta Adhika:
In Sannipat Jvar, where Pitta is mildly dominant, Kapha is moderate and Vata is high, it produces below symptoms –
Shiroruk -headache
Vepathu -trembling, quivering
Shwasa- asthma, respiratory disorders involving difficulty in breathing
Pralapa – irrelevant talk, delirium
Chardi -vomiting
Arochaka -anorexia, lack of interest in food

Heena Pitta Vata Madhya Shleshma Adhika:
In Sannipata Jwara, where Pitta is mild, Vata is moderate and Kapha is high –
Sheetaka- feeling cold
Gaurava – heaviness
Tandra – drowsiness, weakness in sense organs
Pralapa – irrelevant talk, delirium
Asthiruk bone pain
Shiroruk – headache

Heena Kapha, Pitta Madhya, Vata Adhika –
In Sannipata Kwara, where Kapha is mild, Pitta is moderate and Vata is aggressive –
Shwasa asthma, respiratory disorders involving difficulty in breathing
Kasa – cold, cough
Pratishyaya – Running nose
Mukhashosha- dry mouth
Ati Parshwa ruk- severe pain in flanks

Heenakapha Madhya Vata Pitta Adhika –
In Sannipata Jwara where Kapha is mild, Vata is moderate and Pitta is high –

Varcha bheda- Diarrhoea
Agnidaurbalya? loss in the power of digestion
Trishna- thirst
Daha- burning sensation,
Aruchi -anorexia and
Bhrama -giddiness
Sannipata Jwara with all the Three Doshas are equally dominant:
In the Sannipata Jwara in which all the three Doshas are simultaneously vitiated in a similar manner, the signs and symptoms are as follows:

1. The patient at times has burning sensation and at times feels cold.
2. Pain in bones, joints and head.
3. excessive lacrimation and eyes will be cloudy and red. The eye balls are wrinkled.
4. There will be sound (tinnitus) and pain in the ears.
5. The throat will feel as if covered with sharp edged bristles.
6. There will be drowsiness, unconsciousness, delirium, cough, asthma, anorexia and giddiness.
7. The tongue will appear as if burnt (black) and tongue will be rough to touch.
8. There will be prostration.
9. Raktapittasya kaphenonmi?rita Spitting of blood and bile mixed with phlegm
10. The patient will move here and there, there will be thirst, sleeplessness and pain in the cardiac region
11. Sweat, urine and stool will appear very late and they will be in small quantity.
12. The body will not be emaciated in excess.
13. Rumbling sound from the throat.
14. In the skin, urticaria and patches heaving bluish black and red color will appear.
15. The patient will be dumb (absence of speech or difficulty in speech) and there will be inflammation of the channels of circulation.
16. Udara gurutvam There will be heaviness in abdomen.
17. The Doshas will undergo Paka (metabolic transformation) after a long time. [89 109]

In-curability of Sannipata Jwara

If there is obstruction or non elimination of imbalanced Doshas, if the Agni (enzymes which are responsible for digestion and metabolism) is completely destroyed and if all the signs and symptoms are fully manifested, then Sannipata Jwara is incurable; otherwise it is difficult of cure. [109 110]

In the Nidana section, the signs and symptoms of Jwaras caused individually by Vata Pitta and Kapha are described separately. From these signs and symptoms, those of the Dvandvaja types (where 2 Doshas are simultaneously vitiated) and of the Sannipata type (where all the 3 Doshas are simultaneously vitiated) is determined. [110 111]

Agantuja jwara

Agantuja Jwara – Fever by Exogenic factors:
Agantuj (which is cause by external factors) is the 8th type of Jwara. Agantu Jwara is of 4 varieties Viz,
Abhighataja – due to external injury
Abhishangaja – due to excess lust, anger, grief, poison, etc
Abhicharaja – Due to evil tantric rituals
Abhishapaja – due to Shapa (curse) of elderly

Abhigataja jwara

Abhighataja Jwara – Due to injury:
(1) Abhighataja The Jwara caused by the injury of
Shastra – weapons,
Loshtaka – stone, hunter,
Shaka – wood,
Mushti – fist, sole of the palm, teeth and such other factors.

By this injury, Vata vitiates blood resulting in pain, swelling, discoloration and painful fever.

Abhisangaja Jwara

(2) Abhisangaja The Jwara caused by the affliction of passion, grief, fear, anger and evil spirits including germs.
Abhishangaja jwara occurs due to –
Kama – lust
Shoka – grief
Bhaya – fear
Krodha – anger,
Bhuta – evil spirits, micro organisms
Visha – toxins

Due to lust, grief and fear, Vata increases. Due to anger, Pitta aggravates, due to Bhuta (evil spirits / microbes), all the Three Doshas aggravate.

Vishaja Abhishangaja Jwara can occur due to touch or consumption of toxic plants, toxic air, and toxic animals.

Abhicharaja Jwara

(3) Abhicharja The Jwara caused by the contact of the poisonous air of the toxic plants and such other toxins. This type of Jwara gets cured by the administration of antidotes of these poisons.

Abhicharaja fever occurs due to evil deeds and evil tantric rituals. It has Sannipata (aggravation of all the three Doshas).

Abhishapaja Jwara

Abhishapaja is due to curse. It has Sannipata (aggravation of all the three Doshas).
In both the above types, all the features of Sannipata Jwara can be appreciated. Mind, sense organs and body are affected.

Several signs and symptoms caused by the afflication of mind, sense organs an body are also manifested. Abhicaraja and Abhisapaja types of Jwara can be determined from the following:

1. By the direct observation of the performance of evil tantric ritual (Abhicara) and curse (Abhishapa)
2. By hearing from others about it
3. By inference (Anumana) and
4. By the alleviation of Jwara after counteracting their effects.

Different types of Abhishangaja Jwara:

In Kama Abhishangaja Jwara, due to excess lust, patient will have
Dhyana – excessive thoughts, restless
Nishwasa – excess breathing

In Shoka Abhishangaja Jwara, due to grief, crying spells are seen.
In Bhaya Jwara, due to fever, excess tiredness is seen
In Krodhaja Jwara, Pitta symptoms such as redness of face is seen.
In Bhuta Jwara – due to evil spirits /microbes, varied symptoms are observed.
In Visha Jwara –
Murcha – unconsciousness, Moha – confusion
Mada – intoxication
Glani – excess tiredness of sense organs are seen.

In some of these Jwaras, they appear first and then the signs and symptoms of Kama (passion) etc. are manifested, and in others, it happens the other way.

The specific features of Kama (passion) etc. described in the present context of Jwara are also manifested in other diseases (like Unmada or insanity) caused by these factors.

In Kama Jwara etc. the mind is first afflicted by passion etc. but Jwara does not gain strength till such time as the Doshas viz, Vayu etc of the body are not vitiated. Similarly, vitiation of Vayu etc. in the body does not gain power for the production of Jwara till such time as the mind is not afflicted by Kama (passion) etc. [114 128]

The Agantuja Jwaras caused by external factors are in the beginning independent, manifest individual independent signs and symptoms based on cause (fear, anger etc).

Subsequently, they get mixed up with the signs and symptoms of Nija (endogenous) types of Jwara. However, these Agantu Jwaras have their own specific etiological factors and medicines. [128 129]

Jwara Samprapti

Jwara Samprapti – Pathogenesis in general:

The aggravated Doshas – Vata, Pitta and Kapha either individually or in the combinations of two (samsrushta) or all the 3 Doshas (Sannipata) spread through the Rasa Dhatu and dislodge the Jatharagni (digestive fire present in stomach) from its own place. Being supplemented with their own heat and the heat of the Jatharagni, the heat of the body gets increased. Due to this, the body channels (Srotas) get obstructed by the imbalanced Doshas. This leads to further increase in the internal temperature. Thus Jwara manifests with increase in body temperature as its unique sign. [129 132]

Why there is no sweating in initial stages of fever?
Generally a person suffering from Taruna Jwara (first stage of Jwara), does not sweat because of the obstruction to the channels of circulation and the displacement of the Agni (fire). [132 133]

Ama Jwara and Pachyamana Jwara Stages of fever:
Ama and Pachyamana are the two stages of fever. In Ama stage, the digestion strength is very low and it produces Ama – (altered digestion and metabolism).
During Pachyamana stage of Jwara, the Ama slowly starts weak leading to improved digestion strength.

Ama Jwara

Ama Jwara – Ama stage of fever:
Aruchi – Anorexia, lack of interest in food
Avipaka Altered metabolism
Udaragurutva heaviness of stomach
Hrudaya Avishuddhi lack of clarity and purity at heart
Tandra – drowsiness, weakness in sense organs
Alasya – laziness, lethargy
Avisargi, Balavaan – fever has good strength, there is no decrease of temperature
Doshanam Apravartanam – The doshas do not get eliminated out of body
Lala Praseka – excess salivation
Hrullasa – nausea
Kshut Nasha – absence of hunger
Virsa Mukha – tastelessness in the mouth
Stabda – body stiffness
Supta – numbness
Gurugatrata – heaviness
Bahu mutrata Excessive urination
Na vit – ill formed feces or no feces
Jeerna na cha – abscess of digestion process
Glani – debility, fatigue

Pachyamana Jwara

Pachyamana Jwara Lakshana:
The signs and symptoms of Pacyamana stage of Jwara:
Once the Jwara gets past the Ama stage,
Adhika Jwara Vega -Excessive fever
Trushna- thirst
Pralapa- delirium, irrelevant talk
Shwasa – dyspnoea
Bhrama- giddiness
Mala and Shleshma pravrutthi- elimination of feces as well as Phlegm [133 137]

Nirama Jwara

Nirama Jwara Lakshana – Stage of fever when Ama subsides:
Ksut kshamata Appearance of the appetite,
Gatra laghutvam lightness of the body,
Jwara mardavam reduction in temperature,
Dosha Pravritti elimination of Doshas along with waste products from the body [137 138]

Navajwara Apathya

Avoid these things during fever of recent origin – Navajware Apathya:

During Nava Jwara (first stage of Jwara), one should avoid
Divaswapna Sleep during day time
Snana bath
Abhyanga massage
Guru Anna heavy food
Maithuna sexual intercourse
Krodha anger
Pravata exposure to wind,
Vyayama exercise and
Kashaya medicines having astringent taste. [ 138 139]

Langhana or fasting

In the first stage of Jwara, Langhana or fasting is prescribed.

It is however, not indicated in the Jwaras caused by Kshaya (depletion of body tissues), aggravation of Vayu, due to fear, anger, lust, grief and physical exertion. [139 140]

Effects of Langhana:
Langhana (fasting) alleviates the aggravated Doshas and stimulates the Agni (power of digestion). As a result of this, Jwara subsides, the body becomes light and there is appetite.

Langhana is prescribed to the extent that it does not go against the physical strength (Prana Avirodhi). The aim of all therapeutic measures is to maintain the strength of the body by which the patient becomes free from the disease. [140 141]

Nava Jwara Chikitsa

Langhana (fasting),
Svedana (fomentation), Kala (time or passage of eight day),
Yavagu (medicated gruel) with Tikta rasa (medicines having bitter taste) these help in the Pachana (metabolic transformation) of Avipakva Doshas in Taruna Jwara (first stage of fever). [142 143]

Administering hot water to the patient:
If a Jwara patient feels thirsty, then hot water is given if the Jwara is due to Vata or Kapha, or Vata and Kapha simultaneously aggravated.

If the thirst occurs because of Paittik Jwara or as a result of the intake of alcohol, then cold water is given to drink. This cold water should, however, be boiled with bitter medicines.

Both the hot water and cold water (boiled with bitter medicines) are Dipana (digestive stimulant), Pachana (carminative) and elevator of Jwara.

Srotasam Shodhana – They help in the cleansing of the channels of circulation. Balya – They promote strength,
Ruchikara – increase appetite,
Swedakara – promote sweating and
Shivam – auspiciousness. [143 145]

Shadang Paniya

For the alleviation of thirst and Jwara, the patient is given water boiled with

Musta (Cyperus rotundus)
Parpataka – Fumaria parviflora
Ushira Vetiver Vetiveria zizanioides,
Chandana (Sandalwood Santalum album),
Udichya – Pavonia odorata;
Nagara- ginger
After boiling, the water is cooled before administration [145 146]

Vamana treatment for Jwara:

If the Jwara is dominated by Kapha and if it is located in the Amashaya (stomach and small intestine), is in a stage of Utklesa (detached or about to come out), then it is removed by administration of emetics – Vamana.

The state of Kapha is carefully ascertained before the administration of Vamana. [146 147]

Vamana in Jwara

Adverse effects of Emetic therapy – Akale Vamana Prayoga Phala:

If in Taruna (first stage) Jwara, vamana treatment is administered to a patient in whom the Doshas have not reached the above mentioned state, then it causes
Hrdrogam acute heart disease,
Shwasa Asthma,
Anaha obstruction in the movement of flatus, and feces in the intestine and colon and
Moha unconsciousness

Simile: As it is difficult, neither impossible, to take out juice from an unripe fruit, similarly, it is extremely difficult to take out the Ama Dosha pervading all over the body from out of the Dhatus in which they are located. It is likely to cause serious complications. [147 149]

Yavagu and Manda Pana

Yavagu and Manda Pana in Jwara:

Administration of Yavagu (gruel) and Manda (thin gruel) –
After the patient has been administered with Vamana treatment, patient is made to fast. Then Yavagu prepared with Shadanga Paneeya herbs (Musta, Parpata, Usheera, Chandana, Udeechya and Nagara) is administered in appropriate time.

Before administering Yavagu, the patient is given Manda (extremely thin rice gruel). Yavagu and Manda are administered for 6 days or till fever subsides.

As the fire becomes more inflamed by the addition of fuel (Samit), similarly by the administration of gruel, the digestive fire becomes stimulated. These gruel are light for digestion.They help in Anulomana (elimination through downward track) of flatus, urine, feces and Doshas.
Because they are liquid and hot they cause sweating.
Because they are watery in nature, they alleviate thirst.

They sustain Prana (vital force of life) because of their nourishing properties. Because of their laxative property they bring about lightness to the body.
They are wholesome for Jwara.

In view of the above, to a patient suffering from Jwara the wise should administer, in the beginning, with different types of Peya (thin gruel).

Gruel, however, is contraindicated in fever caused by the intake of alcohol, in summer season, when there is predominance of Pitta and Kapha and in Urdhvaga Rakta Pitta (a disease characterised by bleeding from different upper body channels). [149 155]

Tarpana Chikitsa for Jwara

In such cases where administration of Yavagu is prohibited (In high Pitta, in alcoholics etc), the physician should administer in the beginning tarpana prepared of the Laja Saktu (power of field paddy) mixed with honey, sugar and juices which have properties alleviate the Jwara. [ 155 156]

Procedure to be followed after Tarpana treatment:
Post Tarpana procedure:
After the Tarpana is digested, depending upon the wholesomeness and strength of the patient, he is given Mudgayusha – green gram thin soup or meat soup of wild animals (Jangala mamsarasa). Before giving food, the patient ;s teeth is cleared with the twigs of plants. Such plants whose taste can counteract the taste of the mouth of the patient, and which would be relishing, is selected for this purpose.

Danta Dhawana importance

Importance of cleaning teeth – Danta Dhawana
By the cleaning of teeth with the help of twigs, the patient feels freshness in the mouth and appetite for diet and drinks. He becomes capable of appreciating the taste of the food to be taken. After cleaning the teeth with the twigs of the plants, the mouth is cleaned with water for several times. Therefore, he is given Mastu (thin butter milk) juice of sugarcane, alcoholic drinks etc, along with appropriate diet. [156 160]

Kashaya administration

Administration for Kashaya:
After the 6^th day, having light diet to eat, the patient is administered decoctions which are either Pachana (stimulant of digestion) or Shamana (pacifier of Doshas) [160 161]

Adverse effects of astringent Kashaya in Taruna Jwara:

If astringent decoctions are administered in Taruna (first stage of) Jwara, before the 6th day, then, the Doshas get adhered because of stickiness, and do not undergo Paka. This leads to the onset of Vishama Jwara fever (irregular fever).

The former is not prohibited, but the decoction having astringent taste, is prohibited in Taruna (first stage of Jwara fever [161 163]

Administration of light diet

For the alleviation of Jwara fever, up to the 10^th day the patient is given light foods along with Yusha (soup) prepared of vegetables and Pulses and mamsarasa (meat soup) of animals dwelling in the forests (Jangala Mamsarasa). These Yushas and Rasas may or may not be added with sour things. [163 164]

Administration of Ghee

Thereafter, Ghee is administered when there is less Kapha aggravation with dominant Vata and Pitta Doshas. Ghee should only be administered after fever has crossed pachyamana stage (as explained above).

Contribution of ghee and administration of Meat soup:

Ghee should not be administered
if the patient has Kapha dominance and
if the Langhana (lightening) treatment is not appreciated even after 10th day of fever. To such patient, Kashaya (decoction) is given till the body becomes light.

The food in such cases is Mamsa Rasa (meat soup) because it promotes strength, which is capable of inhibiting the Doshas. [165 167]

Administration of Milk

When there is excess of burning sensation and thirst.
When the Jwara is dominated by Vata and Pitta Dosha and
When the Doshas are either Badhha (Adhered), or Pracyuta (slightly dislodged), or
when there is Nirama stage (Pachyamana or Vipakwa stage of Jwara) – in these conditions, milk can be administered. [167 168]

Virechana and Basti in Jwara

Administration of Virechana – Purgation treatment:
When the fever does not subside by the therapies described earlier, then,
If the patient has good Bala (immunity), Mamsa (muscle strength) and Agni (digestion strength), then Virechana can be administered. [168 169]

Administration of Milk and Niruha Basti:

For patients who are severely emaciated by fever, neither Vamana (emesis) nor Virechana is useful. Therefore, it is desirable to remove Malas (waste products) of this patient by the
Oral administration of milk of Niruha Basti (herbal decoction enema).

If Niruha is administrated to a patient when Doshas are in the stage of Paripakva (well cooked), it immediately promotes strength & the power of digestion, alleviates fever and causes happiness as well as relish for food. [169 171]

Importance of Sramsana & Basti:

Sramsana (Purgation) eliminates either Pitta or Kapha or Both of them from the pittashaya (lower stomach and small intestine) Basti eliminates all the 3 Doshas lodged in the Pakvsaya (Colon). [171 172]

Administration of Anuvasana:
In chronic fever, Anuvasana (oil / fat of enema) is given in the following conditions:
When Kapha & Pitta are alleviated
When there is strong digestion strength
When there is constipation or dry feces.

In the present context, the treatment of the chronic fever only is being described. Thus Anuvasana is useful in very chronic cases. [172 173]

Nasya in Jwara

Administration of Nasya – Shiro Virechana treatment:

In Jeerna Jwara (when ama is not there), Shiro Virechana (Nasya treatment to eliminate Doshas from mouth and nose) is administered in the following conditions:
When there is heaviness and pain in the head and
When there is inactivity (vibaddha) of the sense organs, as a result of which these are not able to perceive their objects.[173 174]

Use of Abhyanga, Dhumapana, Anjana

Massage etc therapies for fever:

In Jeerna Jwara, (after passing Ama stage), the following are administered keeping in view, their heating and cooling natures.
Abhyanga (massage)
Pradeha (ointment / unction)
Parisheka (sprinkling of medicated water) and
Avagahana (tub Bath / immersion with medicated water).

By these therapies, the Bahirmarga Gata Jwara (the fever lodged in the external channels of the body) gets alleviated instantaneously.
There is a feeling of ease in the limbs and promotion of strength as well as complexion. [174 176]

Administration of Dhupana, Anjana:
Jeernajwara gets alleviated by the administration of Dhupana (fumigation) and Anjana (collyrium) therapies.
It is especially useful for the residual fever remaining confined only to the skin is associated with Agantu (extraneous) factors. [176 177]

Ingredients for therapies

For the accomplishment of the alleviation of Jwara, proper treatment has been described above. The ingredients used for the therapies described in accordance with this line of treatment are being elaborated henceforth.

Yavagu (rice gruel), Odana (boiled rice) and Laja (fried paddy) are used to mitigate the fever. For these preparations, Rakta Shali (red variety of rice), along with Shashtika type of rice are given after they have become Purana (preserved over one year). [177 179]

10 types of Yavagu

Yavagu – Medicated gruels for Jwara:

Ten types of Yavagus (gruels) used in Jwara are described below:

1. Lajapeya – The drink prepared of fried paddy and boiled with Pippali Long pepper fruit Piper longum and ginger is light for digestion. It alleviates Jwara and is given to the patient in the beginning stage of fever when there is less digestion strength.
2. Amla Peya – If the patient is desirous of sour things and if there is movement of bowel, then the Peya described above is made sour by adding Dadima Pomegranate. It is given along with ginger.
3. In a Paittika type of patient, the above mentioned Peya is cooled and added with honey before administration.
4. The Peya prepared of red variety of rice (Raktashali) and boiled with Gokshura (Tribulus) and Kantakari (Solanum surattense Burm Solanum xanthocarpum) alleviates fever and it is taken by the patient suffering from pain in Parsva (sides of the chest), Basti (urinary bladder) and Shiras (head).
5. The Peya which is sour and which is boiled with Prishnaparni Uraria picta, Bala Country mallow (root) Sida cordifolia, Bilva Bael, ginger, Utpala (Nymphaea alba) and coriander, is taken by a person suffering from Jwara-atisara (fever associated with diarrhea).
6. The Yavagu prepared by boiling with the group of medicines belonging to Vidarigandhadi Gana is stimulant of digestion and it promotes sweating. This Yavagu is taken by a patient suffering from Jwara associated with Kasa (cough), Shvasa (Asthma) and Hikka (hiccup).
7. The Peya prepared of Yava Barley (Hordeum vulgare) boiled with Pippali Long pepper fruit Piper longum and Amalaki causes the Anulomana (which helps in the downward movement of doshas), this Peya, mixed with ghee is taken by a patient suffering from Jwara associated with constipation.

1. The Peya prepare by boiling with raisins, long pepper root, Chavya (Piper chaba), Amalki and ginger is taken by a patient suffering from Jwara associated with constipation and pain.
2. If there is pain in a patient suffering from Jwara then he should take Peya boiled with Bala Country mallow (root) Sida cordifolia, Vruksamla (Citron fruit), Kolamla, Kakasi ( Simha Pucchi), and Dhavani ( Kantakari Solanum surattense Burm Solanum xanthocarpum) along with Bilva Bael.
3. The Peya prepared by boiling with Nagara and Amalaka, fried with ghee and mixed with sugar alleviates Jwara. It is given to the patient suffering from Asveda (absence of sweating), Anidra (sleeplessness) and Trsna ( Morbid thirst). [179 188]

Use of Yusha:
For some patients suffering from Jwara, Yusha gruel prepared with green gram, Masoor dal, Chanaka, horse gram and Makushtaka is useful. [188 189]

Vegetables:
The leaves and fruits of Patola (pointed gourd), Kulaka (Karavallaka – Bitter gourd), Papachelika (Patha – Cissampelos pareira), Karkotaka, Kathilla (red variety of Punarnava Boerhavia diffusa Linn, these vegetables are useful in Jwara. {189 190}

Meat Soup:
The soup prepared of Lava, Kapinjala (white variety of sparrow), Ena (Krishna Shara), Chakora, Upacakraka (a variety of Chakora), Kuranga, Kala Puccha (coppery coloured dear), Prasata (spotted deer) and Shasha (Rabbit) are alleviators of Jwara. These meat soups may be slightly sour or many are free from any sourness. The wise physician should administer these soups at appropriate times.

Some physicians do not advise the use of the soup prepared of the meat of Kukkuta (cock), Mayura (peacock), Tittiri, Kraunca and Vartaka, because they are heavy and hot. In Jwara if Vata gets aggravated because of Langhana (Fasting), then the physician acquainted with the signs of Doshas gives the meat soup of these animals at appropriate times. [190 194]

Anupana (co-Drink):
To a thirsty patient, hot water is given to drink. Depending upon the Doshas involved and the strength of the patient for whom it is wholesome. [194 195]

Diet contra indications

In Nava Jwara (first stage of fever) food ingredients which are heavy, hot, unctuous, sweet and astringent are mostly avoided with a view to facilitate the Paka (metabolic transformation) of Doshas.

Thus, the diet and drinks which are appropriate for the alleviation of Jwara are described. [195 196]

Kashayas for jwara

Kashayas for Jwara – water decoctions

Hereafter, will be described the decoctions to alleviate Jwara. These are as follows:

1 , 2. Musta and Parpataka is taken either in the form of decoction (Pakya) or Sheeta Kashaya (keeping the medicines overnight in water and taking this water in the morning after filtering).

3 The decoction of Parapataka may be given to the patient along with ginger or Duralabha.

4 .The decoction of Kirata Tikta (Swertia chirata), Musta (Cyperus rotundus), Guduchi and ginger.

5 The decoction of Patha and Ushira Vetiver Vetiveria zizanioides along with Udichya.

These kashayas stimulate the power of digestion and help in the Pachana (metabolic transformation) of Doshas.
They alleviate thirst, anorexia and cure Mukha Vairasya (bad taste in the mouth) [197 200]

Kashaya for Vishama Jwara
The five types of Vishama Jwara (recurrent fever) namely, the Santata, Satata, Anyedyuska, Trtiyaka and Chaturthaka, are immediately cured by the five types of decoctions of medicines enumerated below:

1. Kalingaka, leaf of Patola (pointed gourd) and Katukarohini Picrorhiza kurroa
2. Patola, Sariva Indian Sarsaparilla Hemidesmus indicus, Musta (Cyperus rotundus), Patha, and Katukarohini Picrorhiza kurroa
3. Nimba Neem (Azadirachta indica), Patola (pointed gourd), Triphala, raisins, Musta (Cyperus rotundus) and Vatsaka (Holarrhena antidysenterica Wall.)
4. Kiratatikta, Amruta, Chandana (Sandalwood Santalum album) and ginger and
5. Guduchi (Giloy), Amalaka and Musta (Cyperus rotundus) [200 203]

Jwarahara Kashaya:
The decoctions or Sheeta Kashaya of the following medicines is taken by a person for the cure of Jvara:

1. Vatsaka (Holarrhena antidysenterica Wall.), Aragvadha, Patha, Sas Grantha and Katukarohini Picrorhiza kurroa
2. Murva along with Ativisa, Nimba Neem (Azadirachta indica), Patola and Dhanvayasaka and
3. Vacha (Acorus calamus Linn), Musta (Cyperus rotundus), Ushira Vetiver Vetiveria zizanioides, Madhuka Licorice Glycyrrhiza glabra, Musta (Cyperus rotundus), raisins, Kashmarya, Parushaka, Trayamana, Ushira Vetiver Vetiveria zizanioides, Triphala and Katukarohini Picrorhiza kurroa, prepared by keeping overnight, immediately cures the Jwara of living beings. [204 207]

When Doshas are in a state of Vibaddha (adhered to Dhatus) the patient suffering from Jwara should take the decoction of either Jati, Amalaki and Musta (Cyperus rotundus), or that of Dhanvayasaka along with Guda (Jaggery).

The decoction prepared of Triphala, Trayamana, raisins and Katukarohini Picrorhiza kurroa alleviates Pitta and Sleshma. It causes Anulomana (elimination through downward tract) of Doshas. This decoction when taken along with Trivrut and sugar cures Jwara caused by the aggravation of Pitta and Sleshma. [207 209]

Kashayam for Sannipata Jwara:
kashaya prepared of both Brihati Solanum indicum, Kantakari, Vatsaka (Holarrhena antidysenterica Wall.), Musta (Cyperus rotundus), Devadaru, Mahaushadha and Kolavalli cures Sannipata type of Jwara.

The kashaya of Shatyadi Varga:
Shati, Puskaramula, Srungi, Duralabha, Guduchi, ginger, Patha, Kirata, Katukarohini Picrorhiza kurroa.

Cures: Sannipata Jwara along with Kasa (cough), Hrut graha (stiffness in cardiac region), Parshva arti (pain in the sides of the chest), Shvasa (asthma) and Tandra (drowsiness).

Bruhatyadi gana:
Both the varieties of Brihati Solanum indicum, Pauskara, Shati, Srungi, Duralabha, Seeds of Vatsaka (Holarrhena antidysenterica Wall), Patola and Katukarohini Picrorhiza kurroa

Cures: Sannipata Jwara, Kasa (cough) etc. and all types of complications. [210 214]
Different types of decoctions and gruels for the cure of thirst and fever described in first four chapters of Sutra Sthana. Those decoctions can also be used by the physicians for the treatment of Jwara. [215]

Ghee usage in Jwara

Use of Herbal Ghee:
If, in a person having excess dryness, the fever does not get alleviated by the use of Kashayas, Vamana, fasting and by light diet, then it is treated by medicated ghee.

Rooksha – dryness and Tejas – fire elements – both these can cause or worsen fever. So, in a patient with dryness and excess hotness, unctuous foods like ghee is very useful. [216 217]
All the above Kashayas can be administered with ghee as Anupana (co drink) for the alleviation of Jwara fever. They stimulate the power of digestion and endow auspiciousness. [218]

Jwarahara Pippalyadi Ghrita

The medicated Ghee prepared by boiling with
Pippali Piper longum
Chandana Santalum album
Musta – Nut grass (root) – Cyperus rotundus
Usheera Vetiver
Katurohini
Kalingaka
Tamalaki (Bhumyamalaki)
Sariva
Ativisha
Sthira – Desmodium gangeticum
Draksha grapes
Amalaki (Indian gooseberry fruit – Emblica officinalis Gaertn)
Bilva Aegel marmelos,
Trayamana and
Nidigdhika

Cures:
Chronic fever instantaneously
Kshaya (Consumption)
Kasa cough, Cold
Shirashula Headache,
Parshva shula pain in the sides of the chest
Halimaka a type of Jaundice
Amsabhitapa burning sensation in the scapular region and
Vishama Agni irregularity in the power of digestion [219 221]

Vasakadi Ghrita

Decoction is prepared by boiling
Vasa Adhatoda vasica,
Guduchi Tinospora cordifolia
Triphala,
Trayamana and
Yavasaka
Milk is added to it in double the quantity.
To this the paste of
Pippali Piper longum
Musta – Cyperus rotundus
Raisin
Chandana Santalum album
Utpala and ginger is added.
Along with these medicines, ghee is prepared by boiling. This medicated ghee cures Jeerna Jwara (chronic fever). [222 223]

Baladi Ghrita:
A decoction of
Bala – Sida cordifolia
Svadamstra – Gokshura
Bhavani,
Sthira,
Nimba – neem,
Parpataka,
Mustaka,
Trayamana and
Duralabha is prepared.

Paste of the medicines:
Tramalaki – Bhui Amla
Shati – Hedychium spicatum
Draksa raisins
Pushkaramula – Inula racemosa
Meda and
Amalaka

To the above mentioned decoction and paste ghee and milk is added and boiled.
The medicated ghee, thus prepared, is an excellent medicated for the cure of Jwara fever.
It also cures-
Kshaya (chronic bronchitis, tuberculosis)
Kasa cough,
Cold (Bronchitis),
Sirah Sula (Headache),
Parsva sula (pain in the sides of the chest) and
Amsa Tapa (burning sensation in the scapular region) [224 226]

Panchakarma in Jwara

Panchakarma for fever – Elimination of Therapy:

To a patient suffering from Jwara and having highly aggravated doshas; the wise physician should administer elimination therapies in appropriate time for the elimination of Doshas both through the upward tracts.

Administration of Vamana therapy (emesis) by hot water and Madanaphala (Randia spinosa) mixed with Pippali (long pepper), Kalinga or Madhuka alleviates Jwara fever.

The Vamana therapy administered by giving water mixed with honey, sugarcane juice, water mixed with rock salt, alcoholic drinks and Tarpana ( roasted flour of corn diluted with water) is useful in Jwara fever.

A patient suffering from Jwara can be given the juice of raisins and amalaka for Purgation.
Administration of the juice of Amalaka fried with ghee cures Jwara fever.

The following recipes are also useful for a patient suffering from Jwara fever:

1. Avaleha prepared of the power of Trivrt mixed ghee and honey
2. The Juice of Triphala mixed with honey and Ghee
3. Aragvadha along with milk or the juice of Mrdvika
4. Trivrit and Trayamana along with milk
5. Raisins and Abhaya (Haritaki) along with Warm milk or the juice of Draksha as Anupana (Post prandial milk) [ 227 233]

Medicated milk:
By taking milk boiled with Pancamula (Bilva Aegel marmelos, Synonaka, Gambhari, Patala Stereospermum suaveolens and Ganikarika), the patient suffering from Jwara gets cured of
Kasa cough
Shvasa Asthma
Sirah Sula headache
Parsva Sula pain in the sides of the chest and
Chira Jwara chronic fever

The milk boiled either with the castor root or the Shalatu (Unripe fruit cut into pieces) of Bilva Aegel marmelos, when taken, cures fever along with Parikartika (itchy pain) in the abdomen.

The milk boiled with Trikantaka (Gokshura), Bala Country mallow (root) Sida cordifolia, Vyaghri, jaggery and ginger cures Jwara along with Sopha (edema). It also cures the Vibandha (obstruction) of feces and urine.

The liquid prepared by boiling milk with Nagara, Mrdvika and Khajura and added with ghee, honey and sugar cures Jwara associated with thirst.

Milk boiled by adding 4 times of water cures Jwara.

The milk which is Dharoshna (freshly milked from the cow when it is warm) immediately cures Jwara caused by the aggravation of Vayu and Pitta.

Milk alleviates all types of chronic fever. It may be taken either hot or cold, and it can be taken after boiling with medicines appropriate to the type of fever. [234 239]

Niruha basti for Jwara

Niruhabasti for Jwara – Decoction enema:
For the cure of Jwara, when the Doshas are lodged in Pakvasaya (colon), Niruha and Anuvasana types of medicated enema which will be described in Siddhi Sthana, is administered.

All these medicines are boiled in milk by adding water which latter is taken in half the quantity of milk:

Patola
Leaves of Arista
Ushira Vetiver Vetiveria zizanioides
Chaturangula (Cassia fistula)
Hrivera
Katukarohini Picrorhiza kurroa
Tikta
Svadamstra – Gokshura
Madanaphala
Sthira Desmodium gangeticum and
Bala Country mallow (root) Sida cordifolia
After boiling the residue is equal to the quantity of milk.

To this liquid, honey and ghee are added along with the Kalka (paste) of
Madanaphala – Randia spinosa
Musta (Cyperus rotundus)
Pippali Long pepper fruit Piper longum
Madhuka Licorice Glycyrrhiza glabra and
Vatsaka (Holarrhena antidysenterica Wall.).

This potion is administered in the form of enema for the cure of Jwara.

When the channels are cleaned, Doshas are eliminated and Dhatus (tissue elements) are refreshed, the pain in the body disappears and the body becomes light an instantaneously free from fever.

A decoction of-
Aragvadha (Cassia fistula)
Ushira Vetiver Vetiveria zizanioides
Madanaphala
Shalaparni – Desmodium gangeticum
Prishnaparni Uraria picta
Mashaparni Teramnus labialis and
Mudgaparni Phaseolus trilobus is prepared.

To this, the paste of
Priyangu (Callicara macrophylla)
Madana
Musta (Cyperus rotundus)
Shatahva and
Madhuyasti are added, and it is used.

This is an excellent recipe of enema to cure Jwara.

Herbs used for the preparation of a decoction:
Guduchi
Trayamana
Madhuka Licorice Glycyrrhiza glabra
Vrusha – Vasa,
Sthira Desmodium gangeticum,
Bala Country mallow (root) Sida cordifolia
Prishnaparni Uraria picta and
Madana

To this the Meat soup of Jangala type of animals (those inhabiting arid land) to be added.
And the paste of
Pippali Long pepper fruit Piper longum,
Musta and Madhuka Licorice Glycyrrhiza glabra is added.

To this potion, a small quantity of rock salt should also be added along with honey and ghee.

This potion is administered as a Niruha type of medicated enema for the alleviation of Jwara.

It promotes Strength, Sweating and appetite [240 249]

Snehabasti for Jwara

Snehabasti – Oil or fat enema:

A paste of
Jivanti
Madhuka
Meda,
Pippali Piper longum
Madana
Vacha
Ruddhi
Rasna
Bala Abution indicum
Bilva
Shatapuspa and
Shatavari is prepared.

To this, milk, water, ghee and oil is added and boiled.

This medicated ghee is used for Anuvasana type of enema to cure Jwara.

The Sneha (ghee and oil) is boiled with
Patola
Pichumarda
Guduchi Tinospora cordifolia
Madhuka and
Madana
This portion is used as Anuvasana type of enema for the cure of Jwara.
The Sneha (oil and ghee) is boiled with
Chandana Santalum album
Aguru Aqualaria agallocha,
Kashmarya
Patola
Madhuka and
Utpala

This potion is exceeding useful for being administrated as Sneha basti to cure Jwara [250 253]

Shiro Virechana for Jwara

Recipes for inhalations therapy are already described in the 2nd chapter of Sutra Sthana (Bhesajadhyaya) and 8th chapter of Vimana Sthana (Roga Bhesagitiya). A Physician who is well versed with Rationality of the administration of these therapies should given them to the patient for the cure of Jwara.

In the 5th chapter of Sutra Sthana (Matrashiteeya), the medicated oil (Anu Taila) for use as Nasal drop and Dhuma Varti (Cigars for smoking) are described. These should also be administered for the cure of Jwara. [254 255]

Massage etc treatments

Abhyanga (Massage), Pradeha (Unction) and Pariseka medicated bath) is done, either hot or cold, as per the requirement of the two types of Jwara.[256]

Medicated ghee called Sahasra Dhauta ghruta and medicated oil called Chandanadya Taila which alleviate fever associated with burning sensation may be given for massage by the Physician [257]

Chandanadya Taila

Here after the preparation of Chandanadya Taila will be explained. A decoction is prepared of
Chandana (red variety)
Bhadrasri (white variety of Chandana)
Kalanusarya, Kaliyaka, Padma (Prapaundarika), Padmaka, Usheera, Sariva, Madhuka, Magapushpa, Udeechya, Vanya, padma, Utapala, Nalima (a variety of Padma), Kumuda, Saugandhika, Pundarika, Sala Patra Bisa (thread of lotus stalk), Mruvala, Shaivala, Kasheruka, Ananta, Kusha, Kasha, Ikshu, Darbha, Shara, Nala root of Shali, Jambu, Vetasa, Vanira (a variety of Vetasa having roots which are not fragnant), Gundra, Kakubha, Asana, Ashvakarna (A variety of Sala), Syandana (Nemi Vruksa), Vatapotha (Palasa), Shala, Tala, Dhava, Tinisha, Khadira, Kashara, Vitkhala dira, Kadamba, Fruit of Kasmarya, Sarja, Vata (the variety without any adventitious root), Kapitana (which popularly known as Gandhamunda), Udambara, Asvattha, Nyagrodha, Dhataki, Durva, Itkata, Shrungataka, Manjistha, Jyotismati (Kanganika), Seeds of Puskara, Krauncadana, Badari (Ber fruit), Kovidara, Kasali, Samvartaka, Arista (a variety of Nimba growing in hills), Shataparva (Bibitaka), Sita Kumbhika (Kastha Patala), Shatavari, Sriparni, Sravani, Maha Sravani (alambusa having big fruits), Rohini, Sita Paki (Gandhadurva), Odanapaki (Nila Bhendi), Kala (Kakoli), Bala, Payasya, Vidari, Jivaka, Rishabhaka, Meda, Mahameda, Madhurasa, Rushyaprokta, Truna Shunya, Ketaki, Macarsa, Tarusaka, Bakula, Kutaja, Patola, Shalmali, Narikela, Kharjura, Mrudveeka raisins, Priyala, Priyangu, Dhanvana, Atmagupta, Madhuka and such other medicines which are cold in potency.

All these medicines which are readily available are taken for the preparation of this decoction.
This decoction is prepared by adding double the quantity of water.

All the above mentioned medicines also can be used as Kalka (paste).

Oil mixed with the above mentioned decoction and paste is boiled over mild fire till it is reduced to half the quantity of decoction. Massage of this medicated oil instantaneously cures Daha Jwara (fever associated with burning sensation).

The above mentioned medicines is made into a coarse paste and used for unction when it is very cold. The water boiled with these medicines and cooled issued for Avagaha (bath) and Pariseka (Sprinkling over the body).

The Seka (sprinkling over body) and Avagaha (bath) with Madhu (honey), Aranala (sour Gruel), milk, curd, ghee and water instantaneously cure Daha Jwara( fver associated with burning sensation) because of their cold touch. [258 259]

Regimens of fever associated with burning sensation:
A patient suffering from Jwara with burning sensation, should reside in a house cooled by the leaves of Pushkara (Inula racemosa, lotus, Utpala, banana or Kshauma.

The house can also be cooled by the cold water of Sandalwood.
The patient can also stay in a Dhara Gruha (a house which is cooled by a stream of water flowing over or from its roof).

The house can also be cooled by sprinkling of snow water around it. This gives pleasure to the patient. His body is touched with the pleasant touch of gold, conch shell, coral, jewels and pearls which are cooled by the water of sandalwood.

He is consoled by ladies smeared with sandalwood paste and wearing the desirable jewels and pearls. These ladies are affectionate and expert in polite manners.

Diet and drinks which cold, cooling gardens, cold wind and cold rays of the moon these alleviate Jwara with burning sensation. [260 266]

Aguruvadya Taila

Now we are shall explain the therapies like massage etc. for patients suffering from Jwara and for whom hot treatment is desirable.

A decoction is prepared of:
Aguru Aqualaria agallocha
Kushta Saussurea lappa
Tagara Valeriana wallichii
Patra – Cinnamomum tamala
Nalada
Shaileya, Dhyamaka, Harenuka, Sthaauneyaka, Ksemaka (Choraka), Ela Elettaria cardamomum, Varanga, Bala, Pura Guggulu, Tamala Patra, Bhutaika, Rohisha (popularly known as Rama Karpura), Sarala Pinus roxburghii, Shallaki Boswellia serrata, Devadaru Cedrus deodara, Agnimantha Clerodendrum phlomidis Linn.f., Bilva Aegel marmelos, Shyonaka Oroxylum indicum (Linn) Vent, Kashmarya (Gambhari), Patala Stereospermum suaveolens, Punarnava Boerhavia diffusa Linn, Vrushcheera, Kantakari Solanum surattense Burm, Brihati Solanum Indicum Linn, Shalaparni, Prushnaparni, Mashaparni, Mudga Parni, Gokshuraka Tribulus, Eranda Castor, Sobhanjana, Varuna Crataeva nurvala, Arka Calotropis gigantea, Cira Bilva Aegel marmelos, Tilvaka, Shati, Puskara Mula Inula racemosa, Gandira (a Variety of Ramatha), Urubuka, Pattura, Aksiva, Ashmantaka Ficus rumphii, Shigru Bauhinia variegata, Matulunga Citrus medica, Piluka, Mulaka Parni (a variety of Sobhanjana), Tila Parni, Pilu Parni (Morata or Murva), Mesa Srngi Gymnema Sylvestre, Himsra, Danta Shata, Aravata, Bhallataka Semecarpus anacardium, Asphotaka, Andrira, Atmaja (Putranjana), Ekaisika (Ambastha), Karanja Pongamia pinnata (Linn), Dhanyaka Coriandrum sativum, Ajamoda Apium graveolens, Prthvika, Sumakha, Surasa, Kutheraka, Asphotaka, Andira, Atmaja (Putranjama), Ekaisika (Ambastha), Phanijjhaka, Bhustruna, Srungavera, Pippali Piper longum, mustard, Ashvagandha Withania somnifera, Rasna, Ruha (Vruksha Ruha), Roha (Anjalikarika), Yava, Bala, Atibala, Guduchi, Shatapushpa, Sitavalli (Vrksa Kalambuka), Nakuli (Chavika), Gandha Nakuli (a variety of Rasna), Sveta jyotismati, Citraka Plumbago zeylanica, Adhyanda (Sukasimbi), Amla Cangeri, Tila Sesamum indicum, Badara, Kulattha Dolichos biflorus, Masha and such other medicines which are hot in potency

All these medicines or those among them which are available, is taken for the preparation of this decoction.

Paste of these medicines is also prepared.
This decoction and paste, added with
Sura alcoholic drinks
Sauviraka Vinegar
Tushodaka a type of vinegar
Maireya a type of alcoholic drink
Medaka a type of alcoholic drink also called Jagala
Dadhi Manda scum of the curd
Aranala sour gruel and
Katvara curd made watery along with fat is boiled in one Patra (3.072 Lt) of oil.

Indications: When this oil is Luke warm, it is given for massage to a patient suffering from Jwara and for whom hot therapy is indicated.

For the cure of Sita Jwara, the Luke warm water boiled with medicines can also be used for Avagaha (bath) and Pariseka (sprinkling). [267]

Sheetajwara remedy

Remedy for sheetajwara – fever associated with chill, cold:

In the fourteenth chapter of sutra Sthana, 13 varieties of Sweda (fomentation therapy) have been described. A physician who is well versed with their dose and time should administer them for the bed as well as the apparel described there immediately alleviates Sita (cold). Similarly, the thick fumigation of Aguru Aqualaria agallocha alleviates Sheeta – cold.

Passionate ladies, who are beautiful, having a plump body and young, should embrace the patient. Because of the heat of their youth, the Sheeta Jwara is cured.

Different types of diet and drinks which cause fomentation and alleviate Vata and Kapha, instantaneously alleviates Sita Jwara. These should, however, be administered keeping in view the Samsarga (combination of 2 Doshas) and the Bala (strength) of each of these Doshas. (268 271)

Line of treatment

Contra indication for Langhana treatment:
Langhana (fasting) is not useful for patients suffering from Jwara caused by aggravated Vata, and by exhaustion, in chronic fever and also in fever caused by Kshata (external cut injury). Such patients are treated by Shamana (alleviation therapy).

For causing the fever, the aggravated Doshas afflict the Rasa Dhatu and decrease Agni (fire) from the Amashaya (Stomach and Small intestine). Therefore, such patients have less of Agni Bala (power of digestion). Even if a rice pot is kept over the burning fore with sufficient fuel, the rice will not get cooked if the flame of the fire is blown away by a strong wind. Similarly, in a person suffering from fever, the aggravated Doshas thrown the Usma (digestive fire) out of the Pakti sthana (place of digestion).

In this condition the eaten food is not digested. If however, the food is light, it gets digested with difficulty. Therefore, for the preservation of the power of digestion, the line of treatment in the order of Langhana (fasting) etc. is useful.

The Malas (waste Products) of 7 Dhatus (tissue elements) get cooked or metabolized in 7 days. Therefore, generally on the 8 day the Jwara becomes Nirama (free from Ama or Accumulated metabolic waste products).

In the stage, when the Doshas are aggravated and the power of digestion is suppressed, if a person takes food which is especially heavy, he then succumbs to death immediately, or becomes miserable for a long time.

If the Jwara is caused by Vata Dosha, and other Doshas are not associated, then in suppression of the prescribed general rule, the patient is given massage and such other therapies. He is given decoctions and meat or vegetable soup to drink. All the therapies prescribed for the treatment of chronic fever are useful in this condition.

Extended Langhana till 10th day:
|In persons, having Sleshmala type of physical constitution, if fever is caused by excessive Kapha, if Vayu is not aggravated and if there is mild temperature, then because of the excessively mild digestive fire, the stage of Ama Paripaka (metabolic transformation of Ama) is not reached even within a week time. Such patients are kept on fast or are given light food or such other measures till the 10th day. Hereafter, they are treated by the administration of decoction etc. [272 283]

Langhana Therapy:
Langana therapy (fasting) and similar other therapies described in the 22nd chapter of Sutra Sthana should invariably be administered in the following conditions:

1. When the Jwara is in its Sama stage
2. When Kapha is aggravated to produce the Jwara and
3. When both the Kapha and Pitta are aggravated together. [283 284]

Elimination therapies:
For the cure of Jwara caused by the aggravation of Vayu, Pitta and Kapha, Vamana (emesis), Virecana (purgation) and Basti (enema) therapies is administered respectively. [284 285]

Line of treatment of Samsrsta and Sannipatika Jwara fever:
Having ascertained the Samsrsta (Simultaneous vitiation of two Doshas) and Sannipatika (Simultaneous vitiation of all the three Doshas) nature of the disease, the Tara and Tama of the vitiation of dosha or either dual vitiation, the disease fever is treated with appropriate medicines keeping in view the line of treatment prescribed for each Dosha.

Sannipata Jwara is treated by increasing 1 Dosha, by reducing the excessively aggravated one or by correcting the sites of Doshas in order, beginning with the site of Kapha. [285 287]

Parotitis

Inflation near the root of the ear as a sequel of Sannipata Jwara is a serious condition and very few such patients survive. Therefore, efforts is made immediately to cure it by therapeutic measures which alleviate Kapha and Pitta like blood letting, intake of Ghee, Pradeha (application of unction), Navana(inhalation therapy) and Kavala Graha (therapy in which medicines are kept in the mouth). [287 289]

Sakhanusari Jwara

When the Jwara does not get subsided by therapies which are cold, hot unctuous, unctuous etc, then it is diagnosed as Sakhanusari (which is located in the peripheral region of the body) such type of fever gets cured by the administration of blood letting therapy. [289 290]

Jwara fever as a Complication of Visarpa herpes etc:
Diet for Chronic fever:
The chronic fever persists if there is weakness of the Dhatus (Tissue elements) inside the body. Therefore, such patient is given such food which is strength promoting and nourishing [291 292]
Treatment of Trtiyaka and Chaturthaka Jwara:
In the Tritiyaka and Chaturthaka type of Visama Jwara, the line of treatment suggested for the Jwaras in general should not be followed because these 2 types of fever are mostly associated with Agantu or exogenous factors viz, dhatus or evil spirits including germs.

When in these two types of Jwara, Vayu is predominantly aggravated, then it is cured by the administration of ghee, Niruha and Anuvasana types of enema and unctuous as well as hot diet and drinks.

When Pitta is predominant, then the patient is given purgation therapy, medicated milk and ghee and articles which are bitter and cold.

When however, Kapha is predominant, then for the patient, emetic therapy, Pachana (the therapy which promotes metabolism), unctuous diet and drinks, fasting and hot decoctions are useful [292 296]

Vishama Jwara recipes

Recipes for different types of visama Jwara:
Recipes which are very effective in curing Visama Jwara are being described. A wise physician should administer them keeping in view their suitability for the type of Doshas involved. These recipes are as follows:

1. Sura (alcoholic preparation) along with its Manda (upper layer) for use as a drink
2. The meat of cock, Tittiri and peacock for use as food.
3. Intake of (1) the medicated ghee called Satpala, (2) Abhaya (3) decoction of Triphala, (4) Juice of Guduchi, and preparation of nilini (Nilika or Nilabuhna), Ajagandha, Trivrta and Katurohini during the onset of fever. These preparation is administered appropriately after the patient is given Snehana (oleation) and Svedana (fomentation) therapies
4. Emesis after the administration of ghee in large quantity
5. Emesis after taking large quantity of food and drinks
6. Sleeping after taking large quantity of alcohol along with food when the attack of fever
7. Administration of Asthapana and Yapana types of medicated enema
8. Intake of the stool of the cat mixed with milk on the same day.
9. Intake of the stool of the cat mixed with either Dadhi Manda( Scum of the curd), alcohol, rock salt, Pippali, Triphala, curd, butter, milk ghee, Pancagavya (mixture of five products of cow or milk).
10. Intake of Rasona along with oil immediately before food
11. Intake of the meat of animals which are fatty and which are hot in potency
12. Inhalation of Hingu and Vasa (muscle fat) of Vyaghra(tiger) taken in equal quantity and mixed with rock salt
13. Inhalation of old ghee and the Vasa of Simha(lion) along with rock salt
14. Application of Anjana (collyrium) prepared of rock salt, seeds of Pippali and Manahsila mixed with oil
15. Fumigation by Palankasa, Leaves of Nimba, Vacha, Kushta Saussurea lappa, Haritaki, Sarsapa, Yava and ghee
16. Administration of recipes of Dhuma(smoking), Dhupana(fumigation), Navana( Nasal inhalation) and Anjana(Collyrium), which are prescribed in the treatment of Manovikara or psychic ailments like Unmada(insanity) and apasmara(epilepsy)
17. Wearing of Mani( jewels),Ausadha(medicines), Mangalya(auspicious talisman) and Visa(poisonous substances)
18. Intake of Agada (medicines)

Religious rites

Prayer is offered to Lord Ishvara along with Uma, their retinues and Matrs which immediately cures Visama Jwara.

Recitation of the Sahasra names (One thousand names) of Lord Vishnu who has 1000 heads, who is the chief of the caracara (moving and non moving things of the universe) and who is omnipresent, cures all types of Jwara.

Offering prayer (puja) through Isti or Yajna (fire ritual) to Brahma, the Asvins, Indra, Agni, the Himalayas, the Gangas and the retinue of Maruts cures Jwara.

Devotion of father and mother, prayer to gurus, observance of celibacy, practice of penace (tapa) truthfulness, and Niyama (religious rites), Japa(recitation of matras or increations), Homa(offering oblation to fire), hearing the recitation of the Vedas and Darsana (seeing or visiting) of saints immediately cures Jwara. [310 315]

Dhatugata Jwara treatment

Treatment of Dhatugata Jwara fever:
When the Doshas causing are located in the Rasadhatu, then Vamana (emesis) and Upavasa (fasting) is done.

If they are located in the Rakta Dhatu then Seka (fomentation) and Pradeha (application of ointments) is done.

Virecana (purgation) and Upavasa (fasting) is done when the Doshas causing Jwara are located in Mamsa and Medas.

If Asthi and Majja Dhatus are pervaded by these Doshas, then Niruha and Anuvasana types of medicated enema is administered. (315 317)

Agantuja Jwara treatment

Agantuja Jwara Chikitas – Line of treatment of Jwara caused by exogenous factors:

For the Jwara caused by Shapa, Abhichara (black magic), Bhuta (microbes) and Abhishanga (affliction by lust,anger, fear), Daiva Vyapashraya chikitsa (performance of religious rites) is the most preferred therapy.

Jwara caused by Abhighata (external injury) gets cured by the intake and massage of ghee, blood letting and intake of patients are suffering from Anaha (constipation) and are accustomed to alcohol, then they are given food with alcohol and meat soup.

For the treatment of Jwara caused by Ksata (injury like cuts) and Vrana (Ulcers), the line of treatment suggested for the treatment of Kshata (injury) and Vrana (ulcer) is adopted.

The Jwara caused by Kama (passion), Shoka (grief) and Bhaya (fear) gets treated by Ashvasa (consolation), Ishtalabha (providing Kamya Artha (described object), Manojna Artha (Pleasant object), therapies for the alleviation of Pitta and Sadvakya (correct advice, counselling).

The Jwara caused by Krodha (anger) subsides by Kama (passion) and Jwara caused by Kama (passion) gets subsided by Krodha (anger) by the both the Kama and Krodha, Jwaras caused by Bhaya (fear) and Shoka (Grief) get subsided. (317 323)

Psychological fever

If the patient gets Jwara just by the thought of the time of onset of the disease, then his mind is diverted. [323 324]

Jwara Pramoksha Lakshana

Jwara Pramoksha Lakshana – signs that indicate fever is gradually relieving:
Production of Kujana (rumbling) sound, vomiting, Chesta (purposeless movements of limbs), heavy breathing, discoloration, Svinnanga (prostration), trembling, frequent fainting, delirium, at times the whole body becoming hot and at times cold, unconsciousness, more rise of temperature, angry appearance and passage of liquid motion with Doshas and sound along with force these signs and symptoms are manifested at the time of remission of (Sannipata) Jwara. The wise physician should know them.

If a serious type of fever in which Doshas are aggravated in excess is treated with appropriate therapy, then because of Dosha Paka (metabolic changes) there will be sudden (Daruna) remission. This mostly happens in Abhinava (freshly attacked) fever.

In chronic types of fever, because of the Doshas, the temperature rise and then there is gradual remission (Adaruna Moksha) [324 328]

Jwaramukta lakshana

Signs and symptoms when the patient becomes free from Jwara fever:
Disappearance of Klama (mental fatigue) and Santapa (temperature), Absence of Pin, clarity of Senses, and Gaining of natural mental faculty, these are the signs and symptoms of a person who has become free Jwara. [329]
Prohibitions during fever relief period:
Food and drinks which are Vidahi (causing burning sensation) Guru (heavy) Asatmya (Unwholesome) and Viruddha (mutually contradictory), sexual intercourse, excessive avoided by a patient suffering from fever and also when he has become free from fever. By observing these rules, fever gets alleviated and it does not attack again.

Exercise, sexual intercourse, bath, Chankraman (brisk walk) these are avoided by the person who has become free from fever till he regain strength. [330 332]

Punaravartita Jwara

Punaravartita Jwara – Reccurence of fever and its Management:
If a person, who has become free from fever, resorts prohibited factors described above,before gaining strength, the Jwara reappears. If a person becomes free from fever when the Doshas have not been eliminated properly, then, even with mild irregularity in regimens (Apachara), it reappears. There is weakness and loss of vitality in them. If the fever reappears in them then this certainly leads to their death.

Sometimes, Doshas (Malas) undergo Paripaka (metabolic transformation) in the Dhatus (tissue elements) gradually and the fever subsides. But their harmful Dinata (uneasiness), Shvayathu (oedema), Glani (a feeling as if covered with a wet cloth), Panduta (anaemia), loss of appetite, itching, urticaria, pimples and suppression of the power of digestion. Similarly,, other diseases which are already cured reappear in the individual by not eliminating the Doshas regimen after the cure of the disease. Therefore, even after the fever subsides, the Doshas is removed either by elimination or Alleviation therapies depending upon the stage and strength of Doshas. For this purpose, mild elimination therapies and Yapana type of Basti is administered. Yusa (vegetable soups) and Rasa (meat soups) of the meat of Jangala type of animals, which are light are useful in this condition.. Abhyanga (massage), Udvartana (Unction), Snana (bath), dhupana (fumigation), (Anjana (Collyrium) and ghee prepared by boiling with bitter medicines are useful in the treatment of Jwara which has reappeared.

If the fever reappears because of the intake of food which is
Guru (heavy)
Abhisyandi (which obstructs the channels of circulation) and
Unwholesome

Treatment:
Langhana (fasting) and
Hot therapies are administered as described before.
Intake of the decoction of Kirata Tiktaka, Tikta, Musta (Cyperus rotundus), Parpataka and Amrta cures reappeared fever. [333 343]

In different stages of Jwara, the wise physician should treat the patient by the therapies suggested in the line of treatment. [344]

Jwara is the king of diseases.
It causes the death of all creatures and is of serious nature. Therefore, the physician is to make special efforts for its cure. [345]

Yogas mentioned in Sahasra yoga
For vata jvaram
Vata jvarahara kashayam
Vata pitta kapha jvarahara kashayam
Dasamoola Vrishadi kashayam

Pitta jvaram
Pitta jvarahara kashayam
Vata pitta kapha jvarahara kashayam
Sasa Vasadi Kashayam
Mahakushmanda Ghrita
Amrutotthara Taila
Kushmanda Rasayanam

To sum up:
With a desire for the welfare of the living creatures, Atreya has furnished the replies to the queries of Agnivesha regarding the treatment of Jwara. [346]

Thus, ends the 3^rd chapter on the treatment of Jwara (fever) of the Chikitsa section of Agnivesha ;s work as redacted by Charaka.