Puerperal Fever, Causes, Symptoms, Treatment – Sutika Jwara

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

Sutika Jwara means fever occurring in woman during puerperium. Fever manifesting in puerperal woman should be given special attention and treated while following the other regimen of puerperal period.

Sutika – puerperium / puerperal woman
Jwara – fever

Master Kashyapa opines that the fever is the most troublesome amongst all the other disorders. This is true in case of puerperal woman and also in other persons.
Read – Postpartum Afterpains – Causes, Symptoms, Treatment

Types of fever occurring in puerperal women

6 kinds of fevers manifest in puerperal women. These are classified into 2 groups of fevers –

A. Nija Jwara – endogenous fevers caused by doshas

1. Vataja Jwara – fever caused by vitiated vata
2. Pittaja Jwara – fever caused by vitiated pitta
3. Kaphaja Jwara – fever caused by vitiated kapha
4. Sannipataja Jwara – fever caused by vitiation of all three doshas

B. Agantuja Jwara – exogenous fevers

• Stanyottha – caused by breast milk
• Grahottha – caused by grahas
  Read – Human Breast Milk Benefits, Ways To Increase Production

Causes

A. General causes

Master Charaka and Sushruta opine that a woman suffers from fever caused by 2 or 3 doshas or due to trauma (external factors) are caused due to –

• abnormal delivery
• non-congenial diet after normal delivery

Causes for puerperal fever mentioned by Master Kashyapa –

• suppression of natural urges
• excessive dryness caused in the body due to use of dry foods or fat free diet
• excessive hemorrhage
• grief
• use of / exposure to excessive heat or fire
• excessive use of bitter, sour and hot foods
• Day sleep
• exposure to wind blowing from eastern side
• excessive consumption of foods which are heavy to digest and having more moisture
• appearance of milk in the breasts
• woman getting afflicted by grahas
• indigestion
• difficult or abnormal labor
  Read – Untimely and Delayed Labor As Per Ayurveda (Garbha Sangha – Akala Prasava)

Causes of Sannipataja Jwara – fever caused by vitiation of all three doshas in puerperal women (Ka.Sam.Khi.11 / Ka.Sam.Kalpa.8)

• use of incompatible things contrary to each other in terms of qualities
• use of unctuous substances and cold water in the form of bath, drink and with diet

Puerperal woman –

• indulging in coitus
• consuming incompatible / abnormal foods
• awakens all through the night
• sleeps during day time
• suffers from worries, jealousy, greed
• using emaciating measures
• having undergone difficult or abnormal labor
• indulging in many kinds of abnormal activities
  Read – Rakta Vidradhi – Abscess After Childbirth: Causes, Symptoms, Treatment

Pathogenesis

The pathogenesis of Puerperal Fever is explained in Kashyapa Samhita, Khilasthana, 11th chapter.
Due to the over exertion caused by continuous and strong labor pains the body of the puerperal woman becomes languid. As a consequence, vata and other doshas get aggravated, the sense organs get exhausted and the tissues lose their essence due to hemorrhage. Even if a single dosha gets aggravated in this context, it gives enormous trouble to the woman.

Master Kashyapa explains this condition with the suitable similies.

1. It is very difficult to clean an extremely old dirty cloth even for an expert person. The cloth might get torn with slightest negligence. Similarly it becomes extremely difficult to cleanse the body of puerperal woman because the doshas are excessively aggravated and gets adhered to the body parts due to hemorrhage.
2. Due to the looseness of the bonds in the construction, an old house cannot withstand rain, wind and tremors. Just like that the puerperal woman doesn’t tolerate the diseases caused by vata, pitta or kapha due to exhaustion of labor and blood loss.

The doshas in a state of balance sustain the body functions. In case of decline of their balance, the puerperal woman suffers from fever characterized with rise in temperature. The temperature quickly rises just like the dry wood catches fire.

The intensity of fever increases severely due to the below mentioned factors –

• due to use of cold articles
• fasting
• exercise
• tiredness
• consumption of non-congenial foods
• use of other things which tend to cause fever
  Read – Mudha Garbha – Obstructed Labor, Ayurveda Perspective

Signs, Symptoms of Types of Puerperal Fevers

1. Vataja Fever Symptoms

• Irregular temperature – raised temperature in some parts and low temperature in other parts of the body or sudden increase or sudden decrease in temperature
• Body pains
• Yawning
• Horripulation
• Tastelessness
• Feel of astringent taste in the mouth
• Aversion from cold
• Desire for hot things
• Hypersensitiveness / tingling of teeth
• Delirium
• Dry eructation
• Sleeplessness
• Flatulence
• Feel of contraction of body parts

2. Pittaja Fever Symptoms

• Thirst
• Burning sensation
• Delirium
• Vomiting
• Feeling of bitter taste in the mouth
• Yellowish appearance of face, nails, teeth, eyes, feces and urine
• Dryness of the throat
• Feeling as if everything around is burning
• Giddiness
• Desire for cold things

3. Shleshmaja / Kaphaja Fever Symptoms

• Liking for hot things and foods
• Cough
• Headache
• Heaviness of the body
• Low grade fever
• Coryza
• White coloration of urine and feces
• Excessive sleepiness
• Drowsiness
• Dislike for cold articles
• Repeated spitting
• Sweet taste of mouth
• Exhaustion of body
• Aversion towards food

4. Sannipataja Fever Symptoms

• Feeling of coldness in a moment and burning sensation in the other
• Frequent rise and fall of temperature
• Normal digestive power sometimes and abnormal digestive power at other times
• Difficulty in excretion of feces, urine and fart
• Pain in the abdomen due to vata vitiation
• Burning sensation, thirst, delirium and instability of mind due to pitta vitiation
• Heaviness of body parts, feeling of obstruction in the throat and shivering due to kapha vitiation

5. Stanyotpatti Janya Fever Symptoms

On the 4^th or 5^th day after delivery, milk starts appearing in the breasts. This milk reaches the breasts – stanya vaha srotas and influences them to produce the below mentioned symptoms –

• Stiffness of the breasts
• Thirst
• Increased heart beats / tachycardia
• Pain in the belly
• Pain in flanks and sacral regions
• Body ache
• Headache

This fever subsides as soon as the milk is properly drained from the breasts.
Read – Breast Milk Disorders: Symptoms, Detoxification, Remedies

6. Grahottha Fever Symptoms

Below mentioned are the symptoms of fever arising due to sight of grahas, fear, vata, trauma and shaking or trembling –

• Tremors in the whole body
• Crying / deep breathing
• Abnormal visual perceptions
• Tiredness
• Tremors / twitching in hands and eyes
• Yellowness of face and eyes
• Quick alteration in the body complexion into black color or normal color
• Crying and plucking of hair in spite of full consciousness
• Features of vataja fever

This condition shall be treated by administering the treatments to pacify grahas and other treatments prescribed to treat vataja fevers.
Read – Ayurvedic Post Natal Mother Care Based On Season And Place

Treatment of Sutika Jwara

Principles of treating puerperal fever

Dosha Upashamana – The wise physician should try to pacify the doshas which have got aggravated by even the slightest of etiological factors considering the quantity of aggravation.  

Dhatu Prasadana – The tissues should be gratified, purified and strengthened.

Other key measures to treat puerperal fever –

• Swedana – sudation
• Apatarpana – starvation
• Pachana aushadha – use of medicines and measures which are digestive (ama digestive) in nature
• Herbal decoctions
• Massage
• Ghee

Other principles in the treatment of puerperal fever –

Langhana – fasting

When the below mentioned conditions are associated with puerperal fever, the physician should advice fasting –

• Excessive moisture in the body due to vitiation of kapha
• Woman being obese
• Excessive moisture due to presence of ama
• When more blood is not lost through bleeding
• Indigestion
• Woman having unctuous body

After the woman has fasted, manda – thin gruel, scum of boiled rice etc should be served.
Read – Intrauterine Death Of Fetus In Ayurveda

Shamana – pacifying / palliative measures

Puerperal woman should be administered with pacifying or suppressive measures in below mentioned conditions –

• Dryness of the body
• Profuse bleeding
• Emaciation
• Suffering from vata fever
• Hungry
• Thirsty
• Exhausted

She should be prescribed with peyadi krama – sequence of dietetic regimen wherein the food is gradually graduated from liquid to semisolid to solid food over a period of time. If the woman is fasting she should be given with scum of boiled rice etc in that order.

Peya – tisane – increases digestive fire, pacifies the tissues, and removes the abnormalities caused by fetus or delivery. Manda – scum of boiled rice digests ama associated with doshas. Further, medicated or non-medicated soups or meat-soups should be prescribed.

In kapha-pittaja type of fever, pacifying herbs should be used from the 5^th day itself.
Read – Ayurveda Lifestyle and Diet For Fever – 45 Important Things To Know

Kashaya – use of herbal decoctions

Once the doshas (ama associated with) gets digested and fever gets reduced due to consumption of graduated dietetic protocol i.e. samsarjana krama, pachana kashaya – digestive decoction should be prescribed after 5 days and anulomana kashaya – i.e. excretory decoction should be used.

Carminative / excretory decoction should be used in a woman in whom the fever caused due to vata is pacified with use of herbal oil massage and meat soup and when the doshas located in the large bowel are suppressed. For dietetic purpose – light cereals mixed with liquid meat soup of wild animals should be prescribed.
Read – Use Of Water In Fever, Rules, Method, Ayurveda Perspective

Treatment of vata-pittaja fever – Use of ghee

When the fever doesn’t pacify with the above said treatment principles, medicines, therapies or diet, it should be considered as vata-pittaja fever. This type of fever gets pacified only with use of ghee just like the forest fire subsides with rain. Use of ghee is therefore the main treatment once the digestive fire gets purified and disease subsides. Many diseases occurring in woman who has undergone abnormal labor get cured with use of ghee.

Principles of treating sannipata fever – fever caused by all three doshas

In fevers caused due to all three doshas, wherein vata is strong, medicated meat soup or cereals and old ghee should be used.

Shodhana – purifying therapies in puerperal fever

After delivery, the blood gets excreted through uterus. The doshas following the blood also trickle down. In such conditions the doshas in the body are comparatively less in amount. Therefore the cleansing measures of the forms of emetics, sternutatory herbs / errhines, purgatives or enemas should not be given.

The same principle holds good in treatment of puerperal fevers. Woman suffering from puerperal fevers who has lost sufficient amount of doshas from the body should not be administered with strong emetics and purgatives with pungent herbs. Due to the heat generated in the body due to fevers, the tissues undergo suppuration (due to metabolic changes). Use of pungent herbs as emetics or purgatives makes these tissues abnormal.
Read – Vamana – Emesis In Fever

Indication of emetics – Mild emetics should be prescribed in fever caused by kapha –

• associated with nausea
• situation of kapha in chest region
• the woman is tolerant for undergoing emesis

Indication of errhines – Errhines should be prescribed in puerperal fever when

• there is presence of anorexia
• feeling of obstruction in throat
• kapha has reached the head and
• woman is unable to retain mouthful of medicated water given for gargle

Treatment of fever caused by vitiated vata in puerperal woman

1. Sudation – Sankara type of sudation should be administered. It is prepared with –

• meat of carnivorous animals,
• cereals
• black gram
• sesame
• barley
• dasamula – ten roots
• apamarga – Achyranthes aspera
• bhanti
• Castor
• atarusaka – Adhatoda vasica
• ashwagandha – Withania somnifera
• swadamshtra – Tribulus terrestris
• leaves of bamboo tree

All these ingredients should be mixed with powder of cow dung and ground with kanji – fermented liquid is beneficial for giving sudation. It should be a given at the onset of the vataja fever.

2. External applications for convulsions associated with fever –

a. Massage should be given with hot oil. Fumigation should be done with Suradaru – Cedrus deodara. Later lukewarm paste of Sarvagandha herbs i.e. herbs having fragrance prepared with kanji – fermented liquid should be done.

b. Tub bath – should be given with hot kanji – fermented liquid mixed with decoction of the below mentioned herbs –

• syonaka – Oroxylum indicum
• vasa – Adhatoda vasica
• Bamboo
• tarkari – Clerodendrum phlomidis
• Castor
• apamarga – Achyranthes aspera
• kashmari – Gmelina arborea
• bhanga – Cannabis sativa

Fumigation – Fumigation with Guggulu – Commiphora mukul mixed with ghee should be given after tub bath. The woman should then be wrapped with a blanket and seated over a skin-covered seat. Later, she should be given with hot foods and drinks.

3. Use of oils – Dwipanchamuladi oil should be used internally or externally or both forms to cure vata type of fever. (Ka.Sam.Khi.11)

4. Internal medication –  

a. Decoction of Brhat Panchamula or Vidarigandha – Desmodium gangeticum should be given mixed with rock salt

b. Rasnadi Kashayam – Decoction prepared with the below mentioned herbs should be given for oral consumption –

• Rasna – Pluchea lanceolata
• Sarala – Pinus roxburghii
• Devahwa – Cedrus deodara
• Licorice
• Brhati – Solanum indicum
• Daru – Berberis aristata
• Bhargi – Clerodendrum serratum
• Varunaka – Crataeva nurvula
• Erandamula – roots of Ricinus communis
• Vrschikali – Urtica dioica / Tragia involucrate

Following this, decoction water medicated with root of Bilva – Aegle marmelos should be used.

c. Yavadi Ghrta – Ghee prepared with the decoction of below mentioned herbs should be given for oral consumption –

• Barley
• Kola – jujube
• Horse gram
• Dwi Panchamula – Dashamula
• Curds
• Yavakshara – alkali prepared from whole plant of barley
• Chavya – Piper retrofractum
• Chitraka – Plumbago zeulanica
• Ginger
• Pippali – Piper longum

Following the use of this ghee, purgation should be given with ghee medicated and prepared using Shyama – black variety of Operculina turpethum and Tilwaka – Symplocos racemosa.

5. Diet – Food should be taken at proper time. It should include soup prepared with Panchamustika, sour gruels, salt and meat soup of wild animals and birds or that of animals and birds living in desert like / dry regions.

Treatment of fever due to Pitta

1. Principles – Use of hot air is contraindicated since heat or hot things are antagonistic to pitta.

Fever caused due to vitiated pitta when not associated with complications should be treated with

• Application of paste of herbs having astringent, bitter and sweet tastes
• Massage with herbal oils
  Read – Six Tastes Of Ayurveda: Qualities, Benefits, Therapeutic Action (Shad Rasa)

Foods and drinks rich in sour, hot and pungent and bitter things should not be used. The opposite things i.e. foods rich in sweet, bitter and astringent tastes and cold in nature should be used.

2. External application

a. Darvadi Pradeha – The below mentioned herbs should be pestled and the paste should be applied –

• Daru – Cedrus deodara
• Talisa patra – leaves of Abies webbiana
• Ushira – Vetiveria zizanioides
• Sandalwood

b. Madhukadi Taila Abhyanga – Massage should be given using oil prepared with paste of Madhuka – Glycyrrhiza glabra and Tagara – Valeriana wallichii.
Read – Abhyanga Ayurvedic Massage: How To Do? Benefits, Oil Choices

3. Internal medication

a. Sthiradi Kashayam – Decoction prepared with the below mentioned herbs shall be cooled and administered mixed with honey and sugar –

• Sthiradi Panchamula – roots of Desmodium gangeticum, Uraria picta, Tribullus terrestris, Solanum indicum and Solanum xanthocarpum
• Kesara – Crocus sativus
• Kaseruka – Scirpus grossus
• Gopi – Hemidesmus indicus
• Parpataka – Fumaria officinalis
• Ushira – Vetiveria zizanioides
• Coriander

b. Sarvabhishava Raja – The below mentioned herbs are kept in water overnight.

• Musta – Cyperus rotundus
• Sariva dwaya – both types of Hemidesmus indicus and Ichnocarpus frutescens
• Ushira – Vetiveria zizanioides
• Licorice
• Lodhra – Symplocos racemosus
• Padmaka – Prunus cerasoides
• Saptaparna – Alstonia scholaris

Next morning, after straining the contents, it should be mixed with sugar and fine powder of Katuki – Picrorhiza kurroa. This should be given for drinking. This is known as king of beverages used in treatment of fevers.

c. Mrdvikadi Panakam – Sweetened cold percolation of the below mentioned herbs is given –

• Raisins
• Nagapushpa – Mesua ferrea
• Marica – black pepper
• Sugar
• Patra – Cinnamomum tamala
• Cardamom
• Chavya – Piper retrofractum

d. Bhadrashriyadi Kashayam – Decoction of the below mentioned ingredients should be used –

• Bhadrashri – Sandalwoood
• Tinduka – Diospyros malabarica
• Musta – Cyperus rotundus
• Payasya – Ipomoea digitata
• Licorice
• Vacha – Acorus calamus

e. Mudga yusha – Soup of green gram mixed with Prsniparni – Uraria picta and Sthira – Desmodium gangeticum cures fever associated with diarrhea.

f. Laja Peya – Drink prepared with laja – parched paddy – added with the below mentioned herbs cures vomiting, unconsciousness, burning sensation and fever –

• Sariva – Hemidesmus indicus
• Sandalwood
• Ushira – Vetiveria zizanioides
• Raisins
• Padmaka – Prunus cerasoides

This drink should be taken with soup of green gram or decoction of Madhura group of herbs – group of sweet tasting herbs.

g. Madhukadi Leha – Confection prepared with the below mentioned herbs is beneficial –

• Licorice
• Kesara – Crocus sativus
• Gopi – Hemidesmus indicus
• Leaves of Nimba – Azadirachta indica
• Kaseruka – Scirpus grossus
• Sugar
• Honey

h. Madhukadi Taila – Oil prepared using paste of Licorice and Tagara – Valeriana wallichii should be used.

i. Patoladi Ghrta – Ghee prepared with the below mentioned herbs cures fever of pitta origin –

• Patola – Trichosanthes dioica
• Guduchi – Tinospora cordifolia
• Rohini – Picrorhiza kurroa
• Aragwadha – Cassia fistula
• Sandalwood

j. Ghrta – Ghee prepared with Chandanadi group of herbs or Patoladi group of herbs or Tikta Ghrta or Tittiradya Ghrta are beneficial.

k. Sarngishtadi Asava should be given mixed with honey.

4. Virechana and Pradeha – Purgation and unction

After the remission of fever the woman should be given purgation with paste of Chaturangula – Cassia fistula, Raisins and Trivrit – Operculina turpethum. Unction should be given with paste of Devadaru – Cedrus deodara, leaves of Talisa – Abies webbiana, Ushira – Vetiveria zizanioides and Sandalwood.

Treatment of fever caused by vitiated kapha in puerperal woman

1. Principles of treatment

Fever of kapha origins should be treated with the below mentioned remedies after the remission of fever by use of diet given on lines of samsarjana krama i.e. graduated dietetic protocol –

• Bhaishajya pana – drinking of medicines
• Ghee
• Massage

Processed water – Hot water processed with dry ginger and Amaradaru – Cedrus deodara should be given to drink.

Diet – Soup prepared with young radish or meat of animals and birds living in dry / desert like land or meat of wild animals – mixed with bitter and hot herbs and little quantity of fat. Treatment prescribed for vata fever is also beneficial.

Contraindications – Foods and drinks rich in sweet taste, unctuous and heavy should not be used. The foods and drinks having opposite qualities shall be used.

2. External medications

a. Lakshadi Taila Abhyanga – Massage should be given with oil prepared from the below mentioned ingredients –

• Laksha – lac
• Musta – Cyperus rotundus
• Turmeric
• Daruharidra – Berberis aristata
• Shatahwa – Anethum sowa
• Bhadrarohini – Picrorhiza kurroa
• Devapushpa – Vacha – Acorus calamus
• Daru – Cedrus deodara
• Sarala – Pinus roxburghii

b. Kushtadi Taila Abhyanga – Oil prepared with the below mentioned ingredients should be used for massage –

• Kushta – Saussurea lappa
• Agaru – Aquilaria agallocha
• Vyaghranakha – Capparis horrida
• Mamsi – Nardostachys jatamansi
• Coriander
• Ramatha – Ferula narthex – asafetida
• Vakra – Valeriana wallichii
• Harenu – Pisum sativum
• Hribera – Pavonia odorata
• Sthauneya – Taxus baccata
• Kesara – Crocus sativus
• Cinnamon, Cardamom
• Sarala – Pinus roxburghii
• Daru – Cedrus deodara
• Murva – Marsdenia tenacissima
• Kalanusariva – Parmelia perlata
• Barhistha – Pavonia odorata
• Shatapushpa – Anethum sowa
• Prithvika – Cuminum cyminum
• Clove

3. Internal Medication

a. Brihatyadi Kashayam – Decoction prepared with the below mentioned herbs should be use –

• Brihati – Solanum indicum
• Kantakari – Solanum xanthocarpum
• Pushkaramula – Inula racemosa
• Daru – Cedrus deodara
• Pippali – Piper longum
• Ginger
• Shati – Curcuma zedoaria

b. Dwi Panchamuladi Kashayam – Decoction of the below mentioned herbs is useful when used mixed with rock salt –

• Dwi Panchamula – 2 x 5 roots = Dashamula
• Bharangi – Clerodendrum serratum
• Karkata – Pistacia integerrima
• Duralabha – Fagonia cretica
• Nagara – Zingiber officinale
• Pippali – Piper longum
• Daru – Cedrus deodara
  Read – Use Of Herbal Decoctions In Fever -Kashaya In Jwara

c. Patoladi Kashayam – Decoction prepared with below mentioned herbs should be given mixed with honey –

• Pointed gourd
• Coriander
• Musta – Cyperus rotundus
• Murva – Marsdenia tenacissima
• Patha – Cissampelos pareira
• Nidagdhika – Solanum xanthocarpum

d. Purgation – Paste of Trivrt – Operculina turpethum should be given with urine of cow for purgation.

e. Kalyanaka Ghrta and Dashamula Ghrta are beneficial when administered in suitable period in suitable doses.

Treatment of fever caused by all three vitiated doshas in puerperal woman

Fevers caused by vitiation of all three doshas when associated with manifestation of all the clinical features of the doshas will become incurable whereas that with few signs and symptoms is cured with difficulty.

This fever will never get cured in puerperal women who have lost their strength and digestive capacity. It is also incurable in those women who have lost their tissues, strength and ojas – essence of all tissues.
Read – Dhatu – 7 Body Tissues As Explained In Ayurveda

1. Treatment principles

The predominant dosha among the three doshas should be pacified at first. Later the other two doshas should be dealt with.

If all three doshas are equally vitiated, kapha should be treated at first. This is because the kapha it gets adhered to the other doshas, is heavy in nature, gets metabolized with difficulty and is situated in the upper part of the body. After pacifying kapha, the puerperal woman should be treated by considering the stage of fever, on the lines of treating fevers caused by vata, pitta, kapha etc.

Body massage should be given with oil medicated with hot or cold herbs and other measures capable of suppressing tridoshas also should be used.

2. External Medication

Sudation – the below mentioned herbs should be cooked in the form of oleo –

• Kusha – Desmostachya bipinnata
• Kasa – Saccharum spontaneum
• Swadamshtra – Tribullus terrestris
• Arka – Calotropis gigantean
• Sudha – Euphorbia neriifolia
• Castor
• Parushaka – Grewia asiatica
• Shali – Shali rice and other cereals and
• Barley

The cooked ingredients should be spread properly over a sheath of leather and sudation should be given to the woman lying on this oleo after covering her with heavy cloth.

b. Water processed with Haritaki – Terminalia chebula, Priyangu – Callicarpa macrophylla, Malati – Aganosma heynei / Caombretum indicum and Amalaki – Emblica officinalis should be given for mouth wash. Similarly water prepared with Vasa – Adhatoda vasica or Khadira – Acacia catechu should be used.

c. Powdered stone of mango fruit mixed with Rasanjana should be used to rub gums, lips and tongue.

d. Paste of Sarjarasa – Vateria indica, Barley and Ashwagandha – Withania somnifera should be mixed with curd and honey and applied on the forehead of the woman suffering from headache due to high fever.

3. Internal Medication

a. Nagaradi Kashayam – Decoction of the below mentioned ingredients should be given –

• Ginger
• Dashamula – ten roots
• Katwanga – Oroxylum indicum
• Daruka – Argyreia speciosa
• Pippali – Piper longum
• Triphala – Terminalia chebula, Terminalia bellirica and Emblica officinalis
• Bharangi – Clerodendrum serratum
• Karkataka – Pistacia integerrima
• Duralabha – Fagonia cretica

The decoction should be given with rock salt if the fever is rising both in the morning and evening. It should be given with honey and asafetida if the fever is rising only in the evening time.
Read – Ayurveda Home Remedy For Fever

b. Patoladi Kwatha – Decoction of the below mentioned ingredients should be mixed with ghee and given to a woman suffering from sannipata fever with vata predominance –

• Patola – Trichosanthes dioica – pointed gourd
• Musta – Cyperus rotundus
• Licorice
• Rohini – Picrorhiza kurroa etc

The same decoction mixed with honey is a good remedy for sannipata fevers with kapha predominance.

c. Eladi Kashayam – Decoction of the below mentioned should be served to a woman suffering from sannipata fever with pitta predominance, mixed with honey and sugar –

• Cardamom
• Licorice
• Madhuka – Madhuca longifolia
• Rohini – Picrorhiza kurroa
• Shitapaki – Sida cordifolia
• Parushaka – Grewia asiatica
• Triphala – Terminalia chebula, Terminalia bellirica and Emblica officinalis
• Sariva – Hemidesmus indicus
• Patha – Cissampelos pareira
• Manjishta – Rubia cordifolia
• Chaturangula – Cassia fistula

d. Bharangyadi Kashayam – Decoction of the below mentioned herbs should be administered mixed with rock salt and alkali of whole plant of barley so as to cause downward movement of doshas –

• Bharangi – Clerodendrum serratum
• Shringi – Pistacia integerrima
• Trivrt – Operculina turpethum
• Danti – Baliospermum montanum
• Dashamula – 10 roots
• Duralabha – Fagonia cretica
• Katwanga – Oroxylum indicum
• Triphala – Terminalia chebula, Terminalia bellirica and Emblica officinalis
• Ginger
• Pippali – Piper longum

Alternatively Trivrit – Operculina turpethum mixed with cow urine or decoction of Vacha – Acorus calamus should be given. By these measures once the doshas have started moving in their proper channels and the intestine has regained digestive capacity and become strong, properly prepared ghee should be given for drinking purpose.
Read – Role Of Fasting In The Treatment Of Fever – Langhana In Jwara

e. Madhukadi Ghrta – Ghee prepared with the below mentioned herbs should be administered –

• Licorice
• Ativisha – Aconitum heterophyllum
• Rohini – Picrorhiza kurroa
• Bhadradaru – Cedrus deodara

Alternatively Kalyanaka, Mahakalyanaka or Panchagavya Ghrta shall be used.

f. Meat soup and Dashamuladi Kashayam – Meat soup of animals living in desert like / dry lands mixed with old ghee should be administered –

• after lapse of 8 days of fever and later using light diet in samsarjana krama procedure i.e. graduated dietetic regimen and
• if delirium due to predominance of vayu, retention of urine and constipation associated with pain and dyspnea occur in fever caused by 2 doshas or all three doshas

Following this, decoction of the below mentioned ingredients should be given –

• Dashamula – 10 roots
• Horse gram
• Barley
• Kuwala – Ziziphus mauritiana
• Kulirashringi – Pistacia integgerima
• Rasna – Pluchea lanceolata
• Shati – Curcuma zedoaria
• Pushkaramula – Inula racemosa
• Bharangi – Clerodendrum serratum
• Duralabha – Fagonia cretica

g. Pippali Duralabha Kwatha – Decoction of Piper longum and Fagonia cretica is useful.

h. Pippali Mrdvika Kashayam – Decoction of Piper longum and Vitis vinifera should be used.

i. Mangalyaka Ghrta – Ghee is prepared with juice of Guduchi – Tinospora cordifolia and amla along with paste of Sariva – Hemidesmus indicus, Ginger, Lodhra – Symplocos pariera, Pomegranate and Sandalwood is the best to relieve intermittent fevers and is also a useful remedy for all types of fevers.

Treatment of fever caused by breast milk and grahas in puerperal woman

The milk fever or fever caused by breast milk is cured by expressing out the milk. The fever caused due to grahas is cured by measures capable of eradicating grahas and by administering other treatments prescribed for fever due to vata.

In fevers caused by milk, diagnosing of dosha on the basis of specific clinical features, the pacification prescribed for that dosha should be used.

Formulations from Sahasra Yoga Text Book for Sutika Roga
Sutikantak Nasani Gudika
Sutikamaya Nasani Gudika
Bala Koduttuvadi Kashaya
Sahacharadi Kashaya
Jeerakadyarishta

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