Jwara Pravritti, Prakriti: Initiation and Nature of Fever

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Fever is the common ailment which occurs the most in one’s lifetime, than any other disease. It manifests independently and also as a symptom in many diseases. Ayurveda, especially master Charaka has given great importance to fever and has explained it elaborately.
Read – Ayurveda Lifestyle and Diet For Fever – 45 Important Things To Know

Introduction

Fever has been allotted two chapters,

• one in the Nidana sthana dealing with causes, types, and symptoms of fever (Cha.Ni.Sth.Ch 1) and
• another in Chikitsa sthana wherein the treatment details of fever has been discussed in depth (Cha.Chi.Sth.Ch 3)

The term Jwara is not just a ‘raise in temperature of the body’. It is a disturbance, pain and raised heat in physical, mental and sensual planes. Jwara is also a synonym of disease.

Jwara Pravritti means initial manifestation or origin of fever.
Read – Charaka – Jwara Chikitsa 3rd Chapter

The origin of fever

Why should we know the origin of any disease?

Knowing the origin and history of disease gives us evidence about origin of disease, initial causes that led to the manifestation of that disease and the evolution of disease took place with time. This will help us to understand a given disease in present age in comparison to the earlier forms and change in patterns of manifestation of the same disease in the timeline of its evolution.

Sources of origin of fever in Ayurveda
Master Charaka tells that the knowledge of origin of fever can be obtained by two sources –

1. Parigrahat –
In Janapadodhwamsaneeya Vimana Adhyaya, i.e. 3^rd chapter of Vimana Sthana it is explained that the ‘Parigraha i.e. greed of the person to accumulate things’ at the end of Krta or Satya Yuga i.e. the first era will lead to manifestation of fever and other diseases in the future era.
Read – Charaka Janapadoddhvamsaniyam Vimana: 3rd Chapter: Epidemic Diseases

Yuga means era within a four-age cycle. There are four eras –

• Satya / Krta yuga
• Treta yuga
• Dwapara yuga
• Kali yuga

We are now in the Kali yuga. Master Charaka tells that the quality and quantity of life and everything in the creation deteriorates with passage of each era. The nature of people in the creation, their health, attitude, behavior, strength, lifespan, goodness, righteousness, choices of food and means of living, quality of food and crops and almost everything declines with passage of each era. This will eventually lead to manifestation of many diseases including fever.

Events leading to origin of fever

Ref – Cha.Vi.3/23-24
Towards the end of Krta yuga, some well-to-do people started eating too much. This led to increased heaviness in the body. This further led to tiredness, laziness, and desire to accumulate wealth, material, women, progeny and lot more. With time, man became more and more greedy. The desire to accumulate things and increasing greed for the same is called Parigraha.
Read – Sadvritta In Ayurveda – Code Of Conduct For Healthy Life

This carried into the next era, the Treta Yuga. Due to enhanced greed people started cheating each other, telling lies, indulgence in lust, anger, egoism, hatred, cruelty, fear, grief, worries and other perverted mind behaviors. The righteousness reduced by one forth in comparison to the previous era. The ‘time period of Treta yuga’ and quality of everything in the creation too reduced by one forth. The qualities of elements of nature got destroyed. As a result, the goodness and rich properties like taste, potency, etc. of the plants, food and medicines too reduced.

When these foods and herbs which had lost their qualities and potency were consumed by the people of that era, they were deprived of the quality and quantity of nutrition which the people of the earlier eras had enjoyed. Consequentially, these people, for the first time became the victims of many diseases like fever etc. This led to gradual deterioration of lifespan in the succeeding eras.
Read – 16 Tips For A Graceful Ageing: Be Young At 60

2. ‘Nidane purvam uddhishtaa rudra kopam cha daarunaat’ –
The story of development of fever from intense fury of Lord Rudra has been quoted in Nidana Sthana of Charaka Samhita and the related events have been elaborated in Chikitsa Sthana.

a. Mention of ‘Anger of Lord Rudra’ as the origin of fever in Nidana Sthana –

Ref – Cha.Ni.Stha.1/35

Here it is said that fever is manifested from the anger of Lord Rudra / Shiva. The fever is as severe and dangerous as the anger of Lord Rudra which is said to be all consuming. The comparison has been made due to the below mentioned reasons –

• The fever afflicts all life principles and life related activities (Pranas) of all the living beings
• Enhances heat, pain and discomfort in the body, mind and senses
• It reduces the consciousness, intelligence, color, comfort and enthusiasm
• Causes fatigue, loss of consciousness and loss of interest towards food
• Increases pain and temperature in the body
• Other diseases don’t trouble the mankind, doesn’t produce complications and not difficult to treat like fever
• It is considered as leader of all diseases
• It manifests in all living beings
• All living beings are born along with fever and die along with it
• It is considered to be ‘enemy of mankind’ and ‘having the form of death’
• It is the fever which takes away the life of all living beings
  Read – Ayurveda Home Remedy For Fever

b. Elaboration of the story and events related to ‘Fury of Lord Rudra’ related to the origin of fever

Ref – Cha.Chi.3/15-25

In the Treta Yuga i.e. the second era, Lord Shankara / Shiva had vowed to remain ‘anger free’. At that time, the demons started meddling with the peace of sages and people by destroying their penance and rituals. Daksha, who was the manager of creation and also the father-in-law of Lord Shiva, in spite of being capable of destroying those demons remained silent and neglected the menace created by those demons. In between, Daksha arranged for a grand fire sacrifice. In spite of repeated warning and alerts from the other Gods, Daksha ignored keeping the sacrificial portions in the name of Lord Shiva. He even denied and ignored reciting the sacred verses in the name of Lord Shiva mentioned to be read during sacrifices in the Vedas. He did not even give the oblations to the Lord.

When the duration of vow completed, Lord Shiva got extremely disturbed and angry on the negligence of Daksha in terminating the demons and the disrespect shown towards him in the sacrifice.
Read – Ayurveda Home Remedy For Fever And Cold

As a consequence, Lord Shankar’s anger surfaced. He opened his third eye in his forehead and destroyed all the demons from the fire emanating from it. Then, with a determination to destroy the fire sacrifice of Daksha, Lord Shankar created a child named Virabhadra from the fire derived from his anger. This fiery child took rampage and destroyed the sacrifice. Following this, all the Gods were grief struck and suffered from burning sensation and pain. They started running in different directions and got distraught. The worried Gods, along with the 7 great sages started enchanting sacred verses in praise of Lord Shankar until he settled down giving away his anger. On learning this all the Gods saluted Lord Shiva. Now ‘the anger of Lord Shiva’ who had ash in his hand as his weapon, had 3 heads, 9 eyes, his body enveloped with garlands of fire flames, looked fierce-full with small legs and belly, on being thrown away by the Lord, asked in anguish ‘Oh Lord, now that you have discarded me, what shall I do? Since you have settled down I don’t have any relationship with you. Please instruct me!’

Lord Shiva instructed the anger to go down into the creation and get associated with all the living beings. ‘You get into all living beings when they are born or die or when they consume incompatible and unwholesome foods, and be popularly called as Jwara henceforth’.

Thus, Lord Shiva sent his anger into the mortal world in the form of fever. Thus fever has its origin from the anger of Lord Shiva.
Read – Causes, Symptoms, Treatment Of Recurring Fevers – Punaravartaka Jwara

Summary

The fever, according to Ayurveda, has its origin from –

• Greed which masks the wisdom
• Changing choices (bad food choices and lifestyles) with evolution of time
• Reduced righteousness and goodness of the living beings in the timeline of evolution
• Decrease in quality of nature, nature elements, foods, medicines etc. with evolution – this also includes contamination and pollution of nature by man
• Consuming low quality foods, grains, water and air predisposes all living beings to many diseases including fever, lowers immunity
• Emotional highs, mainly excessive anger, as evidenced by story of Lord Shankar’s anger and not willing to let go the anger
  Read – Achara Rasayana – Behavioral Therapy For Calm Mind And Long Life

Even in modern day living, making bad choices of foods and lifestyle practices and stress, geographical variations, abnormal climate changes and pollution adding to it exposes us to large spectrum of diseases. We live amidst everything which is contaminated, including the minds and emotions. The above mentioned explanation is also related to other diseases of the modern day too. This is also because Jwara is a synonym of Vyadhi i.e. disease.

Sowmya, Vatakaphaja, Agneya And Vatapittaja Fever

Sowmya and Agneya Jwara

Sowmya Jwara and Agneya Jwara are the types of fever. They have been named so on the kind of manifestation. Sowmya means mild type and Agneya means severe / aggressive type.

Sowmya and Agneya Jwara have been mentioned in the classification of Jwara in Charaka Chikitsa 3/32 as part of vidhi bhedha i.e. classification on the basis of manifestation and nature of fever. The same concept has been magnified in verse 37.

But the preface of this discussion has been given in Nidana Sthana 1/32 wherein master Charaka tells that Nija Jwaras i.e. fevers manifested on the basis of predominance of doshas, on the basis of involvement of vata and other doshas may be of 2, 3, 4 or 7 types.
Read – Ayurveda Lifestyle and Diet For Fever – 45 Important Things To Know

Master Chakrapani commenting on the above context (Nidana Sthana 1/32) clarifies the dwividha nija jwaras i.e. two types of doshic fevers as –

The two types of nija jwara are shita (sowmya – mild, watery, cold predominant) and ushna (agneya – severe, fiery, heat predominant) jwaras. These may be due to combination of doshas or also due to individual doshas. This means –

Sowmya Jwara may be – Vataja, Kaphaja or VataKaphaja (Vata, kapha and combination of vata and kapha are cold in nature)

Ushna Jwara may be – Pittaja or Vata Pittaja (pitta and combination of pitta and vata are hot in nature)

The reason for Vata partnering in both conditions is given in Chikitsa Sthana Chapter 3 (where further details of these two types of jwara are given) as yogavahitva of vata.

Note – Yogavahitva is a quality attributed to vata. Vata when associated with kapha (both being cold) gets cold. The same vata when associated with pitta gets hot. This happens just like the air flowing on water is cold and that which flows over the fire is hot in nature. This is called as yogavahitva i.e. behavior in accordance to the association.
Read – Ayurveda Home Remedy For Fever

We will now come back to Chikitsa Sthana Chapter 3, verse 32. In its commentary we get to see that –

• Sowmya jwara is caused due to shita karanas – cold causes i.e. etiological factors which increase cold
• Agneya Jwara is caused due to ushna karanas – hot causes i.e. etiological factors which increase heat

This is a hyperlink to what has been explained in Nidana Sthana with clarification. Here this had to be clarified because Charaka also had to add other variants of fever to the Vidhi Bheda classification.

Jumping to verse 37, we get more clarification when we see the below mentioned explanation –

• Vatapittatmaka Jwaras i.e. Agneya Jwaras respond to cold comforts and
• Vatakaphatmaka Jwaras i.e. Sowmya Jwaras respond to hot comforts

Further master Chakrapanai clarifies by telling –

Fevers caused predominantly by vata and also predominantly by kapha being cold natured and being cold in nature respond to hot comforts and remedies. Therefore Vatakaphatmaka fever too responds to hot comforts.

Similarly fevers caused predominantly by pitta being hot in nature respond to cold comforts and remedies. While in Vatapittatmaka fever, vata will follow the heat of pitta being yogavahi and the nature of fever will be hot and thus responds to hot comforts and remedies.
Read – Jwara Pravritti – The Initial Manifestation

Vata Pittaja and Vata Kaphaja Jwaras

These two are the types of samsargaja or dwandwa Jwara i.e. fevers caused by predominance of 2 doshas. Fevers caused by three doshas are called as sannipata jwaras. An interesting point is that these fevers caused by vitiation of two and three doshas have not been detailed by master Charaka in Nidana Sthana. He had reserved them to be described in Chikitsa Sthana.

Importantly we can see a set of etiological factors mentioned for dwidoshaja and tridoshaja fevers being enlisted in the Nidana Sthana. Ref – Cha Ni 1/28.

1. Samanya Nidanas / general etiological factors for aggravation of 2 or 3 doshas –

Etiological factors explained from विषमशनादनशनाद् to मिथ्योपचाराद् (for vikriti vishama samavayarabdha jwaras) count as general etiological factors for fevers caused due to dual (or triple) aggravation of doshas (Cha.Ni.1/28).

The causative factors are –

• Erratic food habits
• Fasting
• Transformation of ingredients of food
• Living against the norms and principles of seasons
• Inhaling incompatible smell
• Drinking water which is mixed with poisons
• Consumption of artificial poisons
• Improper administration of panchakarma procedures
• Not following the dietetic regimen properly after undergoing purification therapies
• Delivery of child in an improper way in women
• Not following conducive foods and lifestyle practices after delivery of the child  
  Read – Charaka – Jwara Chikitsa 3rd Chapter

2. Vishishta Nidanas / specific etiological factors for aggravation of 2 or 3 doshas –

Charaka tells that the etiological factors mentioned for the individual doshas get mixed in twos or threes and cause dwandwaja or sannipataja jwaras. He later tells that the symptoms of the individual doshas which have been mentioned previously are jointly available in the dwandvaja and sannipataja fevers and the diagnosis of these fevers should be done accordingly (for prakriti sama samavayarabdha jwaras).

We get to see some more clarification from Madhava Nidana treatise. Quoting the VataPittaja and VataKaphaja Jwaras from Sushruta Uttara Tantra, the commentator of Madhava Nidana tells that the symptoms of these two fevers are vikriti vishama samavayarabdha. In these fevers we get to see some signs and symptoms which do not belong to the causative doshas. Example, in vata-pittaja fever, horripulation and anorexia are neither the symptoms of vata nor of pitta, they are neither seen in vataja or pittaja fevers. Similarly in Vatashleshmaja fever, sweating and rise of heat (I am not touching upon the other part of explanation to stay with only these two dwandwa jwaras as context of discussion). These symptoms do not look like being caused by the doshas which have been aggravated due to their causative factors.

So we have two types of samsarga here:

Prakriti Sama Samavayarabdha Dwandwaja Jwara – wherein the symptoms will be in accordance to the doshas involved and those doshas would have been aggravated by their respective nidanas. Here the cause and effect relationship is established.

Vikriti Vishama Samavayarabdha Dwandwaja Jwara – wherein at least few symptoms will not be in accordance to the doshas involved and those doshas would not have been aggravated by their respective nidanas. Here the cause and effect relationship is not established.

How dwidoshaja jwaras (vatakaphaja and vatapittaja) differ from sowmya and agneya jwaras?

We can connect the dots from the above found explanation and sum up in this way.

Sowmya and Agneya Bhedas are forms of fever which are caused by cold and hot causative factors respectively. There is prakriti sama samavayarabdha factor involved here. VataKapha and VataPittaja Jwaras need not be caused by cold and hot etiological factors (respectively) as a rule because we also have Vikriti Vishama Samavayarabdha types of these two fevers.

Sowmya and Agneya fevers may be caused by individual or dual doshas. VataKaphaja and VataPittaja Jwaras are essentially caused by combination of two doshas.

Sowmya and Agneya fevers essentially respond to opposite treatments. VataPittaja and VataKaphaja Jwaras need not respond to opposite treatments. On the contrary they may sometimes respond and sometimes not respond to opposite treatments. So there may be recurrence or strange clinical picture involved in these conditions.

VataPittaja Jwara is caused by involvement of vitiated vata and pitta. Here the etiological factors for aggravation of both vata and pitta are needed. Agneya Jwara is caused due to hot causes, followed by aggravation of pitta and later further vitiation of pitta by vata due to yogavahi nature of vata. Here Vata aggravating factors are not needed. But it is still prakriti sama samavayarabdha because pitta has aggravated by its own causes and just has association of vata.

To differentiate these two factors sowmya and agneya jwaras have been mentioned separately. We can see that master Charaka has explained dwandwa jwara lakshanas after the explanation of sowmya and agneya jwara.
Read – Diet and Ayurveda Home Remedy For Fever And Cold

Sanskrit Verses

To sum up –

The dwandwa Jwaras (Vata Pittaja and Vata Kaphaja) or fevers caused by single doshas caused by hot and cold etiological factors respectively following the rule of prakriti sama samavayarabdha principle, cause similar symptoms as that of involved doshas and respond to opposite treatments i.e. cold and hot comforts or remedies are called as agneya and sowmya jwara respectively.

The dwandwa Jwaras (Vata Pittaja and Vata Kaphaja) essentially involving two doshas, caused not essentially by hot and cold etiological factors (may be caused by strange mixing of cold and hot etiological factors), caused by etiological factors unrelated to the aggravation of doshas (some etiological factors may be related to the aggravation of doshas) following the rule of vikriti vishama samavayarabdha principle, cause at least some symptoms not pertaining to either of the involved doshas and need not respond to opposite treatments are vikriti vishama samavayarabdha samsarga jwaras.

Jwara Prakriti – Nature of Fever

The jwara prakrutis are –

• Physical doshas – vata, pitta and kapha
• Mental doshas – raja and tama

This is because the fevers would not manifest without the involvement of these doshas. These doshas, in the state of their aggravation are responsible for the manifestation of fevers. Therefore vata, pitta, kapha, rajas and tamas are the proximal causes of all fevers.

Pratyasanna Karana

Master Chakrapani, commentator of Charaka Samhita, commenting on the word ‘prakruti’ as related to jwara has defined prakruti as ‘pratyasanna karana’ of fevers i.e. the most or closely connected causes for manifestation of fevers.

Sarva dosha avyabhicharat

Fevers are caused by constant, inevitable and absolute involvement of the mentioned physical and mental doshas. This establishes doshas as the prakruti of fevers.
Read – Jwara Pravritti – The Initial Manifestation

Swabhava rupa prakruti of jwara

Prakruti means ‘natural form of fever’

Further Master Charaka tells –
Fever is said to have the ‘form of Yama’ i.e. ‘form of God of death’ due to the below mentioned reasons –  

• Kshaya – depletion (destruction of tissues) – since it causes depletion and destruction of body and body parts
• Tama – darkness – since it causes confusion
• Papma – sin – because it manifests as effect of sinful deeds and activities
• Mrutyu – death – since it causes death (if not treated promptly)

Putting it in other words, the fever, by its nature has the capacity to cause depletion of body, cause confusion as if in darkness, manifest as an effect of sins and also cause death if not treated properly. This is the prakruti of fever. All these have the capacity to take away the life and since the untreated fever also has the capacity to take away the life, just like the God of death, fever is also said to be a form of ‘God of death’.

Kshaya and other entities can also be considered as synonyms of fever. Even in this way all of these will be considered as forms of death. But if we see, kshaya and other entities have their own definition and each can present in the ‘form of death’ and are different from fever. But since the death causing natural form of fever is being explained in this context, it was situational to plug in similar words which serve the same purpose.
Read – Decrease Of Tissues – Dhatu Kshaya – Reasoning, Symptoms

The use of kshaya etc terms in relation to the fever and comparing all these to ‘the form of death’ Master Charaka has put forth the dreadful and life threatening nature of the fever. This calls for a prompt action and comprehensive treatment in all kinds of fever and a shout out that ‘fever of any kind shall not be ignored’.
Commenting on the word mrutyu, Master Chakrapani tells that this word denotes the arishta lakshanas which appear before death. This is because a death cannot be a form of death for itself.
Read – Arishta Lakshanas – Ominous Signs And Symptoms Indicating Bad Prognosis

Why are ‘kshaya etc’ called as forms of death?
They are called as forms of death because they are the causes of death of those persons who are suffering from hardships and miseries as an effect of their deeds (karma).

Sanskrit Verses

Sharirika and Manasika Jwara in relation to Jwara Prakruti
Amongst the classification of fevers, Master Charaka has explained Sharirika Jwara and Manasika Jwara as one of the classification.
Sharirika Jwaras are physical fevers. They first manifest at the physical level and may also afflict the mind in the later period.
Manasika Jwaras are mental fevers. They first manifest at the mental level and can go on to afflict the physical level in later period.
Read – Types Of Jwara According To Ayurveda: Jwara Bheda

This explains and further substantiates the physical and mental doshas being the proximate causes for the causes of the fevers.
Later Master Charaka has mentioned many kinds of fevers. In all fevers we can see the involvement of these doshas. Thus we can conclude that no fever can be manifested without the involvement of the doshas. Thus the doshas are the most proximate causes for all types of fever.

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