Chapter 1 . Jwara Nidana (Chapter on the diagnosis of Fever and other related diseases)

Chapter 1 . Jwara Nidana (Chapter on the diagnosis of Fever and other related diseases)

अथातो ज्वरनिदानं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātō jwaranidānaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

Now I shall expound upon the chapter on the “Diagnosis of Jwara (Fever).”

Thus said Lord Atreya. [1-2]

Nidana (etiology) and its synonyms

इह खलु हेतुर्निमित्तमायतनं कर्ता कारणं प्रत्ययः समुत्थानं निदानमित्यनर्थान्तरम् 

iha khalu hēturnimittamāyatanaṁ kartā kāraṇaṁ pratyayaḥ samutthānaṁ nidānamityanarthāntaram 

1. Hetu, 
2. nimitta, 
3. ayatana, 
4. karta, 
5. karana, 
6. pratyaya and 
7. samutthana 

- are synonyms of nidana (causative factors). 

Types Of Nidana

तत्त्रिविधम्- असात्म्येन्द्रियार्थसंयोगः, प्रज्ञापराधः, परिणामश्चेति||३||

tattrividham-asātmyēndriyārthasaṁyōgaḥ, prajñāparādhaḥ, pariṇāmaścēti||3||

Nidana could be of three types:

1. Asatmyendriyarthasamyoga (unsuitable contact of sense organs with their objects)
2. Pragyaparadha (knowingly engaging in harmful activities), and
3. Kala (seasonal, temporal factors). [3]

Types of diseases

अतस्त्रिविधा व्याधयः प्रादुर्भवन्ति- आग्नेयाः, सौम्याः,वायव्याश्च;-

atastrividhā vyādhayaḥ prādurbhavanti- āgnēyāḥ, saumyāḥ, vāyavyāśca; 

(Physical) diseases caused are of three types, viz., 

1. agneya (pitta-predominant diseases), 
2. saumya (kapha-predominant diseases) and 
3. vayavya (vata-predominant diseases). 

द्विविधाश्चापरे- राजसाः, तामसाश्च||४||

dvividhāścāparē- rājasāḥ, tāmasāśca||4||

Others (mental) are of two types viz. 

1. rajas and 
2. tamas. [4]

Synonyms of disease

तत्र व्याधिरामयो गद आतङ्को यक्ष्मा ज्वरो विकारो रोग इत्यनर्थान्तरम्||५||

tatra vyādhirāmayō gada ātaṅkō yakṣmā jvarō vikārō rōga ityanarthāntaram||5||

1. Vyadhi, 
2. amaya, 
3. gada, 
4. atanka, 
5. yakshma, 
6. jwara, 
7. vikara and 
8. roga 

- are synonyms of disease. [5]

Means for knowledge of disease

तस्योपलब्धिर्निदानपूर्वरूपलिङ्गोपशयसम्प्राप्तितः||6 ||

tasyōpalabdhirnidānapūrvarūpaliṅgōpaśayasamprāptitaḥ ||6 ||

Diseases could be diagnosed by studying their 

1. nidana (etiology), 
2. poorvarupa (premonitory symptoms), 
3. linga (sign and symptoms), 
4. upashaya (exploratory therapy) and 
5. samprapti (pathogenesis).[6]

Definition of Nidana

तत्र निदानं कारणमित्युक्तमग्रे||७||

tatra nidānaṁ kāraṇamityuktamagrē ||7||

Nidana is the etiological factor as described earlier. [7]

Definition of Poorvarupa (premonitory signs)

पूर्वरूपं प्रागुत्पत्ति लक्षणं व्याधेः||८||

pūrvarūpaṁ prāgutpatti lakṣaṇaṁ vyādhēḥ||8||

Symptoms that manifest themselves before the appearance of the disease are known as poorvarupa. [8]

Definition of Linga (sign) and its synonyms

प्रादुर्भूतलक्षणं पुनर्लिङ्गम् 

prādurbhūtalakṣaṇaṁ punarliṅgam

Sign and symptoms when fully manifested are called as linga. 

तत्र लिङ्गमाकृतिर्लक्षणं चिह्नं संस्थानं व्यञ्जनं रूपमित्यनर्थान्तरम्||९||

tatra liṅgamākr̥tirlakṣaṇaṁ cihnaṁ saṁsthānaṁ vyañjanaṁ rūpamityanarthāntaram ||9||

1. Linga, 
2. akruti, 
3. lakshana, 
4. chihna, 
5. samsthana, 
6. vyanjana and 
7. rupa 

- are synonyms of linga. [9]

Definition of Upashaya (pacifying factors)

उपशयः पुनर्हेतुव्याधिविपरीतानां विपरीतार्थकारिणां चौषधाहारविहाराणामुपयोगः सुखानुबन्धः||१०||

upaśayaḥ punarhētuvyādhiviparītānāṁ viparītārthakāriṇāṁ cauṣadhāhāravihārāṇāmupayōgaḥ sukhānubandhaḥ||10||

Medicines, diets and regimens that bring about relief either 

• by acting directly on the cause of a disease 
• or the disease itself 
• or by producing such effects indirectly 

- are termed upashaya (pacifying agents or factors).[10]

Definition of Samprapti (pathogenesis)

सम्प्राप्तिर्जातिरागतिरित्यनर्थान्तरं व्याधेः||११||

samprāptirjātirāgatirityanarthāntaraṁ vyādhēḥ||11||

Samprapti, jati and agati are synonyms of pathogenesis of the disease. 

Like nidana and rupa, samprapti has been described here with its synonyms which are indicative of its definition. [11]

Types of samprapti (pathogenesis)

सा सङ्ख्याप्राधान्यविधिविकल्पबलकालविशेषैर्भिद्यते|१२|

sā saṅkhyāprādhānyavidhivikalpabalakālaviśēṣairbhidyatē|12|

sA sa~gkhyAprAdhAnyavidhivikalpabalakAlavisheShairbhidyate|12|

Samprapti can be further classified, depending upon certain specific characteristics, by sankhya (numerological classification), pradhanya (dominance of dosha), vidhi(types of diseases), vikalpa (dominance of one or the other attributes of doshas), and bala-kala vishesha (the time of manifestation or aggravation of the disease). [12]

सङ्ख्या तावद्यथा- अष्टौ ज्वराः, पञ्च गुल्माः, सप्त कुष्ठान्येवमादिः|१२|

saṅkhyā tāvadyathā-aṣṭau jvarāḥ, pañca gulmāḥ, sapta kuṣṭhānyēvamādiḥ|12|

sa~gkhyA tAvadyathA-aShTau jwaraH, pa~jca gulmAH, sapta kuShThAnyevamAdiH|12|

Sankhya type of classification of samprapti numerically groups diseases by their pathogenesis, such as, eight types of jwara(fever), five types of gulma (abdominal lump), seven types of kushtha (skin diseases), etc. [12.1].

प्राधान्यं पुनर्दोषाणां तरतमाभ्यामुपलभ्यते तत्र द्वयोस्तरः, त्रिषु तम इति|१२|

prādhānyaṁ punardōṣāṇāṁ taratamābhyāmupalabhyatē| tatra dvayōstaraḥ, triṣu tama iti |12|

prAdhAnyaM punardoShANAM taratamAbhyAmupalabhyate| tatra dvayostaraH, triShu tama iti|12|

Pradhanya (classification of samprapti, or pathogenesis) indicates the dominance or primacy of one particular dosha above other doshas. If two doshas get vitiated, the comparative term tara is used to indicate the predominant one. If, all the three doshas get vitiated then the superlative term ttama is used to indicate the most predominant one. [12.2]

विधिर्नाम- द्विविधा व्याधयो निजागन्तुभेदेन,त्रिविधास्त्रिदोषभेदेन, चतुर्विधाः साध्यासाध्यमृदुदारुणभेदेन|१२|

vidhirnāma- dvividhā vyādhayō nijāgantubhēdēna, trividhāstridōṣabhēdēna, caturvidhāḥ sādhyāsādhyamr̥dudāruṇabhēdēna|12|

vidhirnAma- dvividhAvyAdhayonijAgantubhedena, trividhAstridoShabhedena, caturvidhAH sAdhyAsAdhyamRududAruNabhedena|12|

Vidhi or types of diseases can be illustrated as follows

Diseases are of two varieties - nija (endogenous) or agantu (exogenous). On the basis of vitiation of the doshas, diseases could be of three types; they could also be of four varieties, viz. sadhya (curable), asadhya (incurable), mrudu (mild), and daruna (severe). [12.3]

समवेतानां पुनर्दोषाणामंशांशबलविकल्पो विकल्पोऽस्मिन्नर्थे|१२|

samavētānāṁ [1] punardōṣāṇāmaṁśāṁśabalavikalpō vikalpō'sminnarthē|12|

samavetAnAM punardoShANAmaMshAMshabalavikalpo vikalpo~asminnarthe|12|

Predominance of one or the other attribute of the three doshas (in the manifestation of the disease) is known as vikalpa here. [12.4]

बलकालविशेषः पुनर्व्याधीनामृत्वहोरात्राहारकालविधिविनियतो भवति||१२||

balakālaviśēṣaḥ punarvyādhīnāmr̥tvahōrātrāhārakālavidhiviniyatō bhavati||12||

balakAlavisheShaH punarvyAdhInAmRutvahorAtrAhArakAlavidhiviniyato bhavati||12||

Specific time of aggravation and manifestation of diseases is determined on the basis of the variations in seasons, time of the day (or night), and intake of food. [12.5]

तस्माद्व्याधीन् भिषगनुपहतसत्त्वबुद्धिर्हेत्वादिभिर्भावैर्यथावदनुबुद्ध्येत||१३||

tasmādvyādhīn bhiṣaganupahatasattvabuddhirhētvādibhirbhāvairyathāvadanubuddhyēta||13||

tasmAdvyAdhIn bhiShaganupahatasattvabuddhirhetvAdibhirbhAvairyathAvadanubuddhyeta||13||

On the basis of these factors, physicians should properly diagnose a disease without any affliction in mind and intellect (i.e., without any prejudice or preconceived ideas). [13]

इत्यर्थसङ्ग्रहो निदानस्थानस्योद्दिष्टो भवति तं विस्तरेणोपदिशन्तो भूयस्तरमतोऽनुव्याख्यास्यामः||१४||

ityarthasaṅgrahō nidānasthānasyōddiṣṭō bhavati| taṁ vistarēṇōpadiśantō bhūyastaramatō'nuvyākhyāsyāmaḥ||14||

ityarthasa~ggraho nidAnasthAnasyoddiShTo bhavati| taM vistareNopadishanto bhUyastaramato~anuvyAkhyAsyAmaH||14||

In brief, the above topics are the objectives of this section ‘Diagnosis of diseases’ (Nidana Sthana). They will again be discussed in detail later in this chapter. [14]

Origin of jwara

तत्र प्रथमत एव तावदाद्याँल्लोभाभिद्रोहकोपप्रभवानष्टौ व्याधीन्निदानपूर्वेण क्रमेण व्याख्यास्यामः, तथा सूत्रसङ्ग्रहमात्रं चिकित्सायाः| चिकित्सितेषु चोत्तरकालं यथोपचितविकाराननुव्याख्यास्यामः ||१५||

tatra prathamata ēva tāvadādyāmँllōbhābhidrōhakōpaprabhavānaṣṭau vyādhīnnidānapūrvēṇa kramēṇa vyākhyāsyāmaḥ, tathā sūtrasaṅgrahamātraṁ cikitsāyāḥ| cikitsitēṣu [1] cōttarakālaṁ yathōpacitavikārānanuvyākhyāsyāmaḥ [2] ||15||

tatra prathamata eva tAvadAdyAmllobhAbhidrohakopaprabhavAnaShTau vyAdhInnidAnapUrveNa krameNa vyAkhyAsyAmaH, tathA sUtrasa~ggrahamAtraM cikitsAyAH| cikitsiteShu cottarakAlaM yathopacitavikArAnanuvyAkhyAsyAmaH||15||

First described here are the diagnostic features of eight diseases caused due to greed, malice and anger. These would be described along with brief methods of their treatment (a detailed description of their management would be provided in Chikitsa Sthana (of this treatise)). [15]

इह खलु ज्वर एवादौ विकाराणामुपदिश्यते, तत्प्रथमत्वाच्छारीराणाम्||१६||

iha khalu jwara evādau vikārāṇāmupadiśyate, tatprathamatvācchārīrāṇām||16||

iha khalu jvara evAdau vikArANAmupadishyate, tatprathamatvAcchArIrANAm||16||

Jwara (fever) is described first among disorders because temperature (or body heat) is a life-sustaining force, and is the first condition (afflicting patients of somatic conditions). [16]

Types of jwara

अथ खल्वष्टाभ्यः कारणेभ्यो ज्वरः सञ्जायते मनुष्याणां; तद्यथा- वातात्, पित्तात्, कफात्, वातपित्ताभ्यां, वातकफाभ्यां, पित्तकफाभ्यां, वातपित्तकफेभ्यः, आगन्तोरष्टमात् कारणात्||१७||

atha khalvaṣṭābhyaḥ kāraṇebhyo jwaraḥ sañjāyate manuṣyāṇām; tadyathā- vātāt, pittāt, kaphāt, vātapittābhyāṁ, vātakaphābhyāṁ, pittakaphābhyām, vātapittakaphebhyaḥ, āgantoraṣṭamāt kāraṇāt||17||

atha khalvaShTAbhyaH kAraNebhyo jvaraH sa~jjAyate manuShyANAM; tadyathA- vAtAt, pittAt, kaphAt, vAtapittAbhyAM, vAtakaphAbhyAM, pittakaphAbhyAM,vAtapittakaphebhyaH, AgantoraShTamAt kAraNAt||17||

Jwara occurs in humans due to eight causative factors, - vata, pitta, kapha, vata-pitta, vata-kapha, pitta-kapha, vata-pitta-kapha, and agantu (exogenous causes). [17]

तस्य निदानपूर्वरूपलिङ्गोपशयविशेषाननुव्याख्यास्याम||१८||

tasya nidānapūrvarūpaliṅgopaśayaviśeṣānanuvyākhyāsyāmaḥ ||18||

tasya nidAnapUrvarUpali~ggopashayavisheShAnanuvyAkhyAsyAmaH [1] ||18||

Now I shall expound the specific nidana (etiology), poorvarupa (prodromal symptoms), rupa (symptoms) and upashaya (suitable uses) of jwara. [18]

Etio-pathogenesis of vata-dominant jwara

रूक्षलघुशीतवमनविरेचनास्थापनशिरोविरेचनातियोगव्यायामवेगसन्धारणानशनाभिघातव्यवायोद्वेगशोकशोणितातिषेकजागरणविषमशरीरन्यासेभ्योऽतिसेवितेभ्यो वायुः प्रकोपमापद्यते||१९||

rūkṣalaghuśītavamanavirecanāsthāpanaśirovirecanātiyogavyāyāmavegasandhāraṇānaśanābhighātavyavāyodvegaśokaśoṇitātiṣekajāgaraṇaviṣamaśarīranyā
sebhyotisevitebhyo vāyuḥ prakopamāpadyate||19||

rUkShalaghushItavamanavirecanAsthApanashirovirecanAtiyogavyAyAmavegasandhAraNAnashanAbhighAta-vyavAyodvegashokashoNitAtiShekajAgaraNaviShamasharIranyAsebhyo~atisevitebhyo vAyuH prakopamApadyate||19||

Excess use of rough, light to digest, and cold (food), over administration of therapeutic emesis and therapeutic purgation, asthapana (non-unctuous enema), shirovirechana (head evacuation), overexertion, suppression of urges, anashana (fasting), injury, copulation, agitation, lamentation, excessive blood-letting, night vigils and improper/odd posture of body – cause vitiation of vayu [19]

स यदा प्रकुपितः प्रविश्यामाशयमूष्मणा सह मिश्रीभूयाद्यमाहारपरिणामधातुं रसनामानमन्ववेत्य रसस्वेदवहानि स्रोतांसि पिधायाग्निमुपहत्य पक्तिस्थानादूष्माणं बहिर्निरस्य केवलं शरीरमनुप्रपद्यते, तदा ज्वरमभिनिर्वर्तयति||२०||

sa yadā prakupitaḥ praviśyāmāśayamūṣmaṇā saha miśrībhūyādyamāhārapariṇāmadhātuṁrasanāmānamanvavetya rasasvedavahāni srōtāṁsi pidhāyāgnimupahatya paktisthānādūṣmāṇaṁ bahirnirasya kevalaṁ śarīramanuprapadyate, tadā jwaramabhinirvartayati ||20||

sa yadA prakupitaH pravishyAmAshayamUShmaNA [2] saha mishrIbhUyAdyamAhArapariNAmadhAtuM rasanAmAnamanvavetya rasasvedavahAni srotAMsipidhAyAgnimupahatya paktisthAnAdUShmANaM bahirnirasya kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||20||

This vitiated vayu, when it gets into the amashaya (stomach), afflicts agni and vitiates the first dhatu (rasa) created through this vitiated digestion process. This (vitiated admixture of vayu and rasa) blocks the channels associated with rasa and sweda (sweat), adversely affecting the digestive processes and moving that heat out of its locus into other parts of the body. This excess heat leads to jwara. [20]

Clinical features

तस्येमानि लिङ्गानि भवन्ति; तद्यथा- विषमारम्भविसर्गित्वम्,ऊष्मणो वैषम्यं, तीव्रतनुभावानवस्थानानि ज्वरस्य, जरणान्ते दिवसान्ते निशान्ते घर्मान्ते वा ज्वरस्याभ्यागमनमभिवृद्धिर्वा, विशेषेण परुषारुणवर्णत्वं नखनयनवदनमूत्रपुरीषत्वचामत्यर्थं क्लृप्तीभावश्च; अनेकविधोपमाश्चलाचलाश्च वेदनास्तेषां तेषामङ्गावयवानां; तद्यथा- पादयोः सुप्तता, पिण्डिकयोरुद्वेष्टनं, जानुनोः केवलानां च सन्धीनां विश्लेषणम्, ऊर्वोः सादः, कटीपार्श्वपृष्ठस्कन्धबाह्वंसोरसां च भग्नरुग्णमृदितमथितचटितावपाटितावनुन्न-त्वमिव हन्वोश्चाप्रसिद्धिः, स्वनश्च कर्णयोः, शङ्खयोर्निस्तोदः, कषायास्यता आस्यवैरस्यं वा, मुखतालुकण्ठशोषः, पिपासा, हृदयग्रहः, शुष्कच्छर्दिः,शुष्ककासः, क्षवथूद्गारविनिग्रहः, अन्नरसखेदः, प्रसेकारोचकाविपाकाः, विषादजृम्भाविना-मवेपथुश्रमभ्रमप्रलापप्रजागररोमहर्षदन्तहर्षाः, उष्णाभिप्रायता, निदानोक्तानाम-नुपशयो विपरीतोपशयश्चेति वातज्वरस्य लिङ्गानि भवन्ति||२१||

tasyemāni liṅgāni bhavanti; tadyathā-viṣamārambhavisargitvaï, ūṣmaṇo vaiṣamyaṁ, tīvratanubhāvānavasthānāni jwarasya, jaraṇānte divasānte niśānte gharmānte vā jwarasyābhyāgamanamabhivr̥ddhirvā, viśeṣeṇa paruṣāruṇavarṇatvaṁ nakhanayanavadanamūtra-purīṣatvacāmatyarthaï klr̥ptībhāvaśca; anekavidhopamāśc-alācalāśca vēdanāsteṣāï teṣāmaṅgāvayavānāṁ; tadyathā- pādayoḥ suptatā, piṇḍikayorudvēṣṭanaï, jānunoḥ kevalānāï ca sandhīnāï viśleṣaṇaï, ūrvoḥ sādaḥ, kaṭīpārśvapr̥ṣṭhaskandhabāhvaṁsorasāï ca bhagnarugṇamr̥ditamathitacaṭitāvapāṭitāvanunnatvamivahanvoścāprasiddhiḥ, svanaśca karṇayoḥ, śaṅkhayornistodaḥ, kaṣāyāsyatā āsyavairasyaï vā, mukhatālukaṇṭhaśoṣaḥ, pipāsā, hr̥dayagrahaḥ, śuṣkacchardiḥ, śuṣkakāsaḥ, kṣavathūdgāravinigrahaḥ, annarasakhedaḥ, prasekārocakā-vipākāḥ, viṣādajr̥mbhāvināmavepathuśramabhramapralāpapra-jāgararomaharṣadantaharṣāḥ, uṣṇābhiprāyatā, nidānoktānām-anupaśayo viparītopaśayaśceti vātajwarasya liṅgāni bhavanti ||21||

tasyemAni li~ggAni bhavanti; tadyathA- viShamArambhavisargitvam, UShmaNo vaiShamyaM, tIvratanubhAvAnavasthAnAni jvarasya, jaraNAnte divasAnte nishAntegharmAnte vA jvarasyAbhyAgamanamabhivRuddhirvA, visheSheNa paruShAruNavarNatvaM nakhanayanavadanamUtrapurIShatvacAmatyarthaM klRuptIbhAvashca;anekavidhopamAshcalAcalAshca vedanAsteShAM teShAma~ggAvayavAnAM; tadyathA- pAdayoH suptatA, piNDikayorudveShTanaM, jAnunoH kevalAnAM casandhInAM vishleShaNam, UrvoH sAdaH, kaTIpArshvapRuShThaskandhabAhvaMsorasAM ca bhagnarugNamRuditamathitacaTitAvapATitAvanunnatvamiva [6] ,hanvoshcAprasiddhiH, svanashca karNayoH, sha~gkhayornistodaH, kaShAyAsyatA AsyavairasyaM vA, mukhatAlukaNThashoShaH, pipAsA, hRudayagrahaH,shuShkacchardiH, shuShkakAsaH, kShavathUdgAravinigrahaH, annarasakhedaH, prasekArocakAvipAkAH,viShAdajRumbhAvinAmavepathushramabhramapralApaprajAgararomaharShadantaharShAH, uShNAbhiprAyatA, nidAnoktAnAmanupashayo viparItopashayashcetivAtajvarasya [7] li~ggAni bhavanti||21||

Symptoms of vata-dominant jwara

The patient would experience abrupt onset and remission (of fever), with variations in temperature and severity. Jwara would be particularly severe at the end of digestion and there would be temporal variations as well (i.e., day, night and in summer). The patient’s skin would appear rough, and there would be reddish discoloration of nails, eyes, face, urine, stool and skin. The patient would experience excessively reduced tendency to pass urine, feces, excessive tearing of nails, etc. Debilitating pain radiating from the toe up, with various sensations felt at various parts as the pain travels – numbness in feet, cramps in the calves, looseness in knee joints (and also in all other joints), weakness in thighs, excruciating pain in the waist region, aching in the sides, pressure sensation in back, churning in shoulder, cutting in arms, extracting in scapular region and constricting feeling in chest, inability to move the jaws, tinnitus, and piercing pain (pricking pain) in the temple region. (Other symptoms include) astringent taste or lack of taste in the mouth (distaste), dryness of mouth, palate and throat, thirst, catching pain (grabbing pain) in the heart, dry vomiting, dry cough, loss of sneezing and eructation, aversion to the taste, salivation, anorexia, diminished digestive power, malaise, increased yawning, bending, shivering, exhaustion, giddiness, delirium, insomnia, horripilation, sensitivity in teeth, and the desire for hot. Factors mentioned in the etiology are alleviating and contrary to them are aggravating. [21]

Pitta dominant jwara

उष्णाम्ललवणक्षारकटुकाजीर्णभोजनेभ्योऽतिसेवितेभ्यस्तथा तीक्ष्णातपाग्निसन्तापश्रमक्रोधविषमाहारेभ्यश्च पित्तं प्रकोपमापद्यते||२२||

तद्यदा प्रकुपितमामाशयादूष्माणमुपसृज्याद्यमाहारपरिणामधातुं रसनामानमन्ववेत्य रसस्वेदवहानि स्रोतांसि पिधाय द्रवत्वादग्निमुपहत्य पक्तिस्थानादूष्माणं बहिर्निरस्य प्रपीडयत् केवलं शरीरमनुप्रपद्यते, तदा ज्वरमभिनिर्वर्तयति||२३||

तस्येमानि लिङ्गानि भवन्ति; तद्यथा- युगपदेव केवले शरीरे ज्वरस्याभ्यागमनमभिवृद्धिर्वा भुक्तस्य विदाहकाले मध्यन्दिनेऽर्धरात्रे शरदि वा विशेषेण,कटुकास्यता,घ्राणमुखकण्ठौष्ठतालुपाकः, तृष्णा, मदो, भ्रमो, मूर्च्छा, पित्तच्छर्दनम्, अतीसारः, अन्नद्वेषः, सदनं, खेदः, प्रलापः, रक्तकोठाभिनिर्वृत्तिः शरीरे, हरितहारिद्रत्वं नखनयनवदनमूत्रपुरीषत्वचाम्, अत्यर्थमूष्मणस्तीव्रभावः, अतिमात्रं दाहः, शीताभिप्रायता, निदानोक्तानुपशयो विपरीतोपशयश्चेति पित्तज्वरलिङ्गानि भवन्ति||२४||

uṣṇāmlalavaṇakṣārakaṭukājīrṇabhojanebhyotisevitebhyastathā tīkṣṇātapāgnisantāpaśramakrodhaviṣamāhārebhyaśca pittaṁ prakopamāpadyate||22||

tadyadā prakupitamāmāśayādūṣmāṇamupasr̥jyādyamāhāra-pariṇāmadhātuṁ rasanāmānamanvavetya rasasvedavahāni srotāṁsi pidhāya dravatvādagnimupahatya paktisthānādūṣ-māṇaï bahirnirasya prapīḍayat kevalaï śarīramanu-prapadyate, tadā jwaramabhinirvartayati||23||

tasyemāni liṅgāni bhavanti; tadyathā- yugapadeva kevale śarīre jwarasyabhyagamanamabhivéddhirvā bhuktasya vidāhakāle madhyandinerdharātre śaradi vā viśeṣeṇa, kaṭukāsyatā, ghrāṇamukhakaṇṭhauṣṭhatālupākaḥ, tr̥ṣṇā, mado, bhramo, mūrcchā, pittacchardanaï, atīsāraḥ, annadvēṣaḥ, sadanaṁ, khedaḥ, pralāpaḥ, raktakoṭhābhinirvr̥ttiḥ śarīre, haritahāridrat-vaṁ nakhanayanavadanamūtrapurīṣatvacāï, atyarthamūṣmaṇ-astīvrabhāvaḥ, atimātraṁ dāhaḥ, śītābhiprāyatā, nidānoktānupaśayo viparītopaśayaśceti pittajwaraliṅgāni bhavanti||24||

uShNAmlalavaNakShArakaTukAjIrNabhojanebhyo~atisevitebhyastathA tIkShNAtapAgnisantApashramakrodhaviShamAhArebhyashca pittaMprakopamApadyate||22||

tadyadA prakupitamAmAshayAdUShmANamupasRujyAdyamAhArapariNAmadhAtuM [1] rasanAmAnamanvavetya rasasvedavahAni srotAMsi pidhAyadravatvAdagnimupahatya paktisthAnAdUShmANaM bahirnirasya [2] prapIDayat kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||23||

tasyemAni li~ggAni bhavanti; tadyathA- yugapadeva kevale sharIre jvarasyAbhyAgamanamabhivRuddhirvA bhuktasya vidAhakAle madhyandine~ardharAtre sharadivA visheSheNa, kaTukAsyatA, ghrANamukhakaNThauShThatAlupAkaH, tRuShNA, mado, bhramo, mUrcchA, pittacchardanam, atIsAraH, annadveShaH, sadanaM,khedaH, pralApaH, raktakoThAbhinirvRuttiH sharIre, haritahAridratvaM nakhanayanavadanamUtrapurIShatvacAm, atyarthamUShmaNastIvrabhAvaH, atimAtraMdAhaH, shItAbhiprAyatA, nidAnoktAnupashayo viparItopashayashceti pittajvarali~ggAni [3] bhavanti||24||

Excess use of hot, sour, salty, alkali, pungent and bitter food and intake of meals before the digestion of the previous meal, contact with intense heat, fire, exhaustion due to excessive exercise, anger, untimely meals – vitiate pitta. The vitiated pitta enters the amashaya and gets mixed with the initial dhatu formed in the process, rasa, along with the digested food. This improperly formed rasa causes sluggish circulation and further block the micro channels of rasa and sweda. The core digestive agnigets displaced out of its original site (pakti sthana), spreading out through the body. Due to blocked channels of sweat, heat dissipation is adversely affected, causing the temperature to rise all over the body and manifest as paittika jwara.

The symptoms of this type of jwara include simultaneous high fever in the whole body, specially at the time during digestion of meals, midday, middle of the night or in the Autumn season. This type of fever leaves a pungent taste in the mouth, paka (ulceration or inflammation) of the nose, mouth, throat, lips and palate, unquenchable thirst, narcosis, giddiness, fainting, vomiting of pitta (bile), atisara (diarrhea), aversion to food, malaise, dejection, delirium, appearance of reddish patches in the body, green or yellow coloration in nails, eyes, mouth, urine, feces and skin, excessive migraine and burning sensation, desire for cold things, unsuitability of included factors in etiology and suitability of opposite ones – these symptoms are of pitta (or paittika) jwara. [22-24]

Kapha-dominant jwara

स्निग्धगुरुमधुरपिच्छिलशीताम्ललवणदिवास्वप्नहर्षाव्यायामेभ्योऽतिसेवितेभ्यः श्लेष्मा प्रकोपमापद्यते||२५||

स यदा प्रकुपितः प्रविश्यामाशयमूष्मणा सह मिश्रीभूयाद्यमाहारपरिणामधातुं रसनामानमन्ववेत्य रसस्वेदवहानि स्रोतांसि पिधायाग्निमुपहत्य पक्तिस्थानादूष्माणं बहिर्निरस्य प्रपीडयन् केवलं शरीरमनुप्रपद्यते, तदा ज्वरमभिनिर्वर्तयति||२६||

snigdhagurumadhurapicchilaśītāmlalavaṇadivāsvapnaharṣāvyāyāmebhyo´tisēvitebhyaḥ śleṣmā prakōpamāpadyate ||25||

sa yadā prakupitaḥ praviśyāmāśayamūṣmaṇā saha miśrībh- ūyādyamāhārapariṇāmadhātuï rasanāmānamanvavetya rasa-svedavahāni srotāṁsi pidhāyāgnimupahatya paktisthānādūṣ-māṇaï bahirnirasya prapīḍayan kevalaï śarīramanupra-padyate, tadā jwaramabhinirvartayati||26||

snigdhagurumadhurapicchilashItAmlalavaNadivAsvapnaharShAvyAyAmebhyo~atisevitebhyaH shleShmA prakopamApadyate||25||

sa yadA prakupitaH pravishyAmAshayamUShmaNA sahamishrIbhUyAdyamAhArapariNAmadhAtuM rasanAmAnamanvavetya rasasvedavahAni srotAMsipidhAyAgnimupahatya paktisthAnAdUShmANaM bahirnirasya prapIDayan kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||26||

Excessive use of unctuous, heavy, sweet, slimy, cold, sour, salty substances, day sleep, joy and a sedentary lifestyle –vitiate sleshma or kapha. [25] The vitiated kaphaenters the amashaya and gets mixed with the initial dhatu formed in the process, rasa, along with the digested food. This improperly formed rasa cause sluggish circulation and further block the micro channels of rasa and sweda. The core digestive agni gets displaced out of its original site (pakti sthana), spreading out through the body. As channels of sweat are blocked and are unable to dissipate the heat, temperature rises all over the body, causing jwara. [26]

तस्येमानि लिङ्गानि भवन्ति; तद्यथा- युगपदेव केवले शरीरे ज्वरस्याभ्यागमनमभिवृद्धिर्वा भुक्तमात्रे पूर्वाह्णे पूर्वरात्रे वसन्तकाले वा विशेषेण, गुरुगात्रत्वम्, अनन्नाभिलाषः, श्लेष्मप्रसेकः, मुखमाधुर्यं, हृल्लासः, हृदयोपलेपः, स्तिमितत्वं, छर्दिः, मृद्वग्निता, निद्राधिक्यं, स्तम्भः,तन्द्रा, कासः, श्वासः, प्रतिश्यायः, शैत्यं, श्वैत्यं च नखनयनवदनमूत्रपुरीषत्वचाम्, अत्यर्थं च शीतपिडका भृशमङ्गेभ्य उत्तिष्ठन्ति, उष्णाभिप्रायता, निदानोक्तानुपशयो विपरीतोपशयश्च; इति(श्लेष्मज्वरलिङ्गानि भवन्ति)||२७||

tasyemāni liṅgāni bhavanti; tadyathā-yugapadeva kevale śarīre Jwarasyābhyāgamanamabhivr̥ddhirvā bhuktamātre pūrvāhṇe pūrvarātre vasantakāle vā viśeṣeṇa,gurugātratvaṁ,anannābhilāṣaḥ,śleṣmaprasekaḥ,mukhamādhuryaṁ,hr̥llāsaḥ,hr̥dayopalepaḥ,stimitatvaṁ,chardiḥ,mr̥dvagnitā,nidrādhikyaṁ,stambhaḥ,tandrā,kāsaḥ,
śvāsaḥ,pratiśyāyaḥ,śaityaṁ,śvaityaṁ ca nakhanayanavadanamūtrapurīṣatvacāṁ, atyarthaṁ ca śītapiḍakā bhr̥śamaṅgebhya uttiṣṭhanti, uṣṇābhiprāyatā, nidānoktānupaśayo viparītopaśayaśca; iti (śleṣmajwaraliṅgāni bhavanti)||27||

tasyemAni li~ggAni bhavanti; tadyathA- yugapadeva kevale sharIre jvarasyAbhyAgamanamabhivRuddhirvA bhuktamAtre pUrvAhNe pUrvarAtre vasantakAle vAvisheSheNa, gurugAtratvam, anannAbhilAShaH, shleShmaprasekaH, mukhamAdhuryaM, hRullAsaH, hRudayopalepaH, stimitatvaM, chardiH, mRudvagnitA,nidrAdhikyaM, stambhaH, tandrA, kAsaH, shvAsaH, pratishyAyaH, shaityaM, shvaityaM ca nakhanayanavadanamUtrapurIShatvacAm, atyarthaM ca shItapiDakAbhRushama~ggebhya [2] uttiShThanti, uShNAbhiprAyatA, nidAnoktAnupashayo viparItopashayashca; iti (shleShmajvarali~ggAni [3] bhavanti)||27||

The symptoms of shleshmaja (kaphaja) jwara include the simultaneous onset of mild fever in the whole body, specially just after meals, forenoon, early night or spring season. This type of fever causes heaviness in the body, less desire to eat, excess secretion of shleshma (phlegm), sweet taste in the mouth, nausea, coating in the heart (causing wheezing), vomiting, mild appetite, excessive sleep or narcolepsy, stiffness, drowsiness, cough, dyspnea, coryza, coldness, whiteness in nails, eyes, face, urine and skin, urticarial patches in the body, desire to be subjected to heat, unsuitability of the described etiological factors and suitability of opposite to them. [27]

विषमाशनादनशनादन्नपरिवर्तादृतुव्यापत्तेरसात्म्यगन्धोपघ्राणाद्विषोपहतस्य चोदकस्योपयोगाद्गरेभ्यो गिरीणां चोपश्लेषात् स्वेदवमनविरेचनास्थापनानुवासनशिरोविरेचनानामयथावrयोगाrथ्यासंसर्जनाद्वा स्त्रीणां च विषमप्रजननात् प्रजातानां च मिथ्योपचाराद्यथोक्तानां च हेतूनां मिश्रीभावाद्यथानिदानं द्वन्द्वानामन्यतमः सर्वे वा त्रयो दोषा युगपrकोपमापद्यन्ते,ते प्रकुपितास्तयैवानुपूर्व्या ज्वरमभिनिर्वर्तयन्ति||२८||

viṣamāśanādanaśanādannaparivartādr̥tuvyāpatterasātmyagandhopaghrāṇādviṣopahatasyacodakasyopayogādgarebhyo girīṇāṁ copaśleṣāt snehasvedavamanavirecanāsthāpanānuvāsanaśirovirecanānāmayathāvatprayogāt mithyāsaṁsarjanādvā strīṇāṁ ca viṣamaprajananāt prajātānāṁ ca mithyopacārādyathoktānāṁ ca hetūnāṁ miśrībhāvādyathānidānaṁ dvandvānāmanyatamaḥ sarve vā trayodoṣā yugapat prakopamāpadyante,te prakupitāstayaivānupūrvyājwaramabhinirvartayanti ||28||

viShamAshanAdanashanAdannaparivartAdRutuvyApatterasAtmyagandhopaghrANAdviShopahatasya codakasyopayogAdgarebhyo girINAM copashleShAtsnehasvedavamanavirecanAsthApanAnuvAsanashirovirecanAnAmayathAvatprayogAt mithyAsaMsarjanAdvA strINAM ca viShamaprajananAt prajAtAnAM camithyopacArAd yathoktAnAM ca hetUnAM mishrIbhAvAdyathAnidAnaM dvandvAnAmanyatamaH sarve vA trayo doShA yugapat prakopamApadyante, teprakupitAstayaivAnupUrvyA jvaramabhinirvartayanti||28||

Irregular diet, fasting, change in regular meals, seasonal derangement, unsuitable odors, use of hilly water full of poisonous sediments, improper medication by ghee, oils and fats, medical fomentations, emesis, purgation, oily or decoction enema, nasal instillations, faulty diets after purification therapies, women undergoing abnormal delivery and inappropriate post-partum management - these are some of the etiological factors that have already been mentioned as causes of vitiation of doshas, that cause fever. [28]

Sannipatika jwara

तत्र तथोक्तानां ज्वरलिङ्गानां मिश्रीभावविशेषदर्शनाद्द्वान्द्विकमन्यतमं ज्वरं सान्निपातिकं वा विद्यात्||२९||

Tatra tathoktānāṁ jwaraliṅgānāṁ miśrībhāvaviśeṣadarśanāddvāndvikamanyatamaṁ Jwaraṁ sānnipātikaṁ vā vidyāt ||29||

tatra tathoktAnAM jvarali~ggAnAM mishrIbhAvavisheShadarshanAddvAndvikamanyatamaM jvaraM sAnnipAtikaM vA vidyAt||29||

When the symptoms exhibit the dominance of two doshas, it is called sansrishta (dwandaja) jwara and in case all three doshas are vitiated, it is called sannipatika jwara (tridoshic fever). [29]

Agantu jwara (fever of exogenous origin)

अभिघाताभिषङ्गाभिचाराभिशापेभ्य आगन्तुर्हि व्यथापूर्वोऽष्टमो ज्वरो भवति| स किञ्चित्कालमागन्तुः केवलो भूत्वा पश्चाद्दोषैरनुबध्यते|तत्राभिघातजो वायुना दुष्टशोणिताधिष्ठानेन,अभिषङ्गजःपुनर्वातपित्ताभ्याम्,अभिचाराभिशापजौ तु सन्निपातेनानुबध्येते||३०||

abhighātābhiṣaṅgābhicārābhiśāpebhya āganturhi vyathāpūrvo´ṣṭamo jwaro bhavati.Sa kiñcitkālamāgantuḥ kevalo bhūtvā paścāddoṣairanubadhyate.Tatrābhighātajovāyunā duṣṭaśoṇitādhiṣṭhānena, abhiṣaṅgajaḥ punarvātapittābhyāï, abhicārābhiśāpajau tu sannipātenānubadhyete||30||

bhighAtAbhiSha~ggAbhicArAbhishApebhya Aganturhi vyathApUrvo~aShTamo jvaro bhavati| sa ki~jcitkAlamAgantuH kevalo bhUtvA pashcAddoShairanubadhyate| tatrAbhighAtajo vAyunA duShTashoNitAdhiShThAnena, abhiSha~ggajaH punarvAtapittAbhyAm, abhicArAbhishApajau tu sannipAtenAnubadhyete||30||

Agantuja jwara (jwara caused due to exogenous factors) is the eighth type of fever. This fever is accompanied with pain and is often caused by trauma, association with evil, fascination, and wrath (of the wise and the elders). These causes directly manifest as fever without any prodromal symptoms for a transitional duration. Slowly, with the passage of time, doshas get vitiated and their effects manifest as above. Fevers caused due to trauma influence blood pathology, while association with evil afflicts vata and pitta, and fascination and wrath causes sannipata (and therefore, leads to an incurable condition). [30]

स सप्तविधाज्ज्वराद्विशिष्टलिङ्गोपक्रमसमुत्थानत्वाद्विशिष्टो वेदितव्यः,कर्मणा साधारणेन चोपचर्यते इत्यष्टविधा ज्वरप्रकृतिरुक्ता||३१||

sasaptavidhājjvarādviśiṣṭaliṅgopakramasamutthānatvādviśiṣṭo veditavyaḥ,karmaṇÁ āsādhāraṇena copacaryate.Ityaṣṭavidhā jwaraprakr̥tiruktā||31||

sa saptavidhAjjvarAdvishiShTali~ggopakramasamutthAnatvAdvishiShTo veditavyaH, karmaNA sAdhAraNena copacaryate [1] | ityaShTavidhA jvaraprakRutiruktA||31||

All the seven doshic jwara have their own doshic specifications with respect to the onset, symptomatology, and treatment principles. The exception is the agantuja jwara (exogenous), which should be treated with appropriate consideration to the jwara’s specific etiology. [31]

ज्वरस्त्वेकएवसन्तापलक्षणः|तमेवाभिप्रायविशेषाद्द्विविधमाचक्षते,निजागन्तुविशेषाच्च|तत्र निजं द्विविधं त्रिविधं चiतुर्विधं सप्तविधं चाहुर्भिषजो वातादिविकल्पात्||३२||

Jwarastvekaevasantāpalakṣaṇaḥ.Tamevābhiprāyaviśeṣāddvividhamācakṣate,nijāgantuviśeṣācca.Tatra nijaṁ dvividhaṁ trividhaṁ caturvidhaṁ saptavidhaṁ cāhurbhiṣajo vatādivikalpāt||32||

jvarastveka eva santApalakShaNaH| tamevAbhiprAyavisheShAddvividhamAcakShate, nijAgantuvisheShAcca| tatra nijaM dvividhaM trividhaM caturvidhaM saptavidhaM cAhurbhiShajo vAtAdivikalpAt||32||

Per doshic classification of jwara, santapa (excessively hot sensation) is of only one type common to all jwara. But according to other classifications it is of two types - nija (endogenous) and agantuja (exogenous). Nija again could be classified into two types (saumya or mild) and agneya (high grade fever)), three types (vatika, paitika, shleshmika), four types (vatika, paittika, sleshmika and agantuja), or seven types (vatika, paittika, shleshmika, vata-paittika, vata-shleshmika, pitta-shleshmika). [32]

General premonitory signs of all jwara

तस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा-मुखवैरस्यं,गुरुगात्रत्वम्, अनन्नाभिलाषः, चक्षुषोराकुलत्वम्,अश्र्वागमनं, निद्राधिक्यम्, अरतिः, जृम्भा, विनामः, वेपथुः,श्रमभ्रमप्रलापजागरणरोमहर्षदन्तहर्षाः,शब्दशीतवातातपसहत्वासहत्वम्, अरोचकाविपाकौ, दौर्बल्यम्, अङ्गमर्दः, सदनम्, अल्पप्राणता, दीर्घसूत्रता, आलस्यम्, उचितस्य कर्मणो हानिः, प्रतीपता स्वकार्येषु, गुरूणां वाक्येष्वभ्यसूया, बालेभ्यः प्रद्वेषः, स्वधर्मेष्वचिन्ता, माल्यानुलेपनभोजनपरिक्लेशनं,मधुरेभ्य भक्षेभ्यः प्रद्वेषः, अम्ललवणकटुकप्रियता च,इति ज्वरस्य पूर्वरूपाणि भवन्ति प्राक्सन्तात्;अपिचैनंसन्तापार्तमनुब||३३||

tasyemāni pūrvarūpāṇi bhavanti; tadyathā- mukhavairasyaṁ, gurugātratvaṁ, anannābhilāṣaḥ, cakṣuṣorākulatvaṁ, aśrvāgamanaṁ, nidrādhikyam, aratiḥ, jr̥mbhā, vināmaḥ, vepathuḥ, śramabhramapralāpajāgaraṇaromaharṣadantaharṣāḥ, śabdaśītavātātapasahatvāsahatvaṁ, arocakāvipākau, daurbalyaṁ, aṅgamardaḥ, sadanaṁ,alpaprāṇatā, dīrghasūtratā, ālasyaṁ, ucitasya karmaṇo hāniḥ, pratīpatā svakāryēṣu, gurūṇāṁ vākyeṣvabhyasūyā, bālebhyaḥ pradveṣaḥ,svadharmeṣvacintā,mālyānulēpanabh-ojanaparikleśanaṁ,madhurebhyaśca bhakṣebhyaḥ pradveṣaḥ,amlalavaṇakaṭukapriyatā ca, iti jwarasyapūrvarūpāṇi bhavantiprāksantāpāt; api cainaṁ santāpārtamanubadhnanti||33||

tasyemAni pUrvarUpANi bhavanti; tadyathA- mukhavairasyaM, gurugAtratvam, anannAbhilAShaH, cakShuShorAkulatvam, ashrvAgamanaM, nidrAdhikyam, aratiH,jRumbhA, vinAmaH, vepathuH, shramabhramapralApajAgaraNaromaharShadantaharShAH, shabdashItavAtAtapasahatvAsahatvam, arocakAvipAkau, daurbalyam,a~ggamardaH, sadanam, alpaprANatA, dIrghasUtratA, Alasyam, ucitasya karmaNo hAniH, pratIpatA svakAryeShu, gurUNAM vAkyeShvabhyasUyA, bAlebhyaHpradveShaH, svadharmeShvacintA, mAlyAnulepanabhojanaparikleshanaM, madhurebhyashca bhakShebhyaH pradveShaH, amlalavaNakaTukapriyatA ca, iti jvarasyapUrvarUpANi bhavanti prAksantApAt; api cainaM santApArtamanubadhnanti||33||

Premonitory symptoms of jwara include abnormal taste in the mouth, heaviness in the body, aversion to food, restless eyes, lacrymation, excessive sleep, restlessness body, yawning, bending, shivering, exhaustion (without exercise), giddiness, delirium, sometimes sleeplessness, horripilation, oversensitive teeth, tolerance and intolerance to sound, cold, wind and heat, anorexia, indigestion, weakness, body-ache, malaise, reduced vitality, mental agitations, lethargic, idleness, lack of natural activities, apathy to daily regimen, disrespect to the words of elders, agitation with children, aversion to doing work, uncomfortable with flowers and perfumes, aversion to sweet edibles, and desirous for sour, salty and pungent things. These premonitory symptoms rise before the onset of jwara and may continue through the course of the fever. [33]

इत्येतान्येकैकशो ज्वरलिङ्गानि व्याख्यातानि भवन्ति विस्तरसमासाभ्याम्||३४||

ityetānyekaikaśo Jwaraliṅgāni vyākhyātāni bhavanti vistarasamāsābhyām||34||

ityetAnyekaikasho jvarali~ggAni vyAkhyAtAni bhavanti vistarasamAsAbhyAm||34||

Thus the symptoms of separate single doshic jwara are described in details and double and triple doshic jwara are described in brief [34].

Consequence of jwara

ज्वरस्तु खलु महेश्वरकोपप्रभवः,सर्वप्राणभृतां प्राणहरो,देहेन्द्रियमनस्तापकरः,प्रज्ञाबलवर्णहर्षोत्साहह्रासकरः,श्रमक्लममोहाहारोपरोधसञ्जननः; ज्वरयति शरीराणीति ज्वरः, नान्ये व्याधयस्तथा दारुणा बहूपद्रवा दुश्चिकित्स्याश्च यथाऽयम्| स सर्वरोगाधिपतिः, नानातिर्यग्योनिषु च बहुविधैः शब्दैरभिधीयते|सर्वे प्राणभृतः सज्वरा एव जायन्ते सज्वरा एव म्रियन्ते च; स महामोहः, तेनाभिभूताः प्राग्दैहिकं देहिनः कर्म किञ्चिदपि न स्मरन्ति, सर्वप्राणभृतां च ज्वर एवान्ते प्राणानादत्ते||३५||

JwarastukhaluMaheśvarakopaprabhavaḥ,sarvaprāṇabhr̥tāṁprāṇaharo,dehendriyamanastāpakaraḥ,prajñābalavarṇaharṣotsāhahrāsakaraḥśramaklamamohā
hāroparodhasañjananaḥ; jwarayati śarīrāṇīti jwaraḥ, nānye vyādhayastathā dāruṇā bahūpadravā duścikitsyāśca yathāyam. Sa sarvarogādhipatiḥ, nānātiryagyoniṣu ca bahuvidhaiḥ śabdairabhidhīyate.Sarve prāṇabhr̥taḥ sajvarā eva jāyante sajvarā eva mriyante ca; sa mahāmohaḥ, tenābhibhūtāḥ prāgdaihikaṁ dehinaḥ karma kiñcidapi na smaranti, sarvaprāṇabhr̥tāṁ ca jwara evānte prāṇānādatte||35|| jvarastu khalu maheshvarakopaprabhavaH, sarvaprANabhRutAM prANaharo, dehendriyamanastApakaraH, praj~jAbalavarNaharShotsAhahrAsakaraH [1] ,shramaklamamohAh
Aroparodhasa~jjananaH; jvarayati sharIrANIti jvaraH, nAnye vyAdhayastathA dAruNA bahUpadravA dushcikitsyAshca yathA~ayam| sa sarvarogAdhipatiH, nAnAtiryagyoniShu ca bahuvidhaiH shabdairabhidhIyate| sarve prANabhRutaH sajvarA eva jAyante sajvarA eva mriyante ca; sa mahAmohaH, tenAbhibhUtAH prAgdaihikaM dehinaH karma ki~jcidapi na smaranti,sarvaprANabhRutAM ca jvara evAnte prANAnAdatte||35||

Jwara occurs due to the wrath of Maheshwara. It could take away the life of all creatures, causes santapa (grief) in body, sense organs and mind. It reduces intellect, strength, complexion, feeling of happiness and enthusiasm and produces tiredness, fatigue, confusion, aversion to food. In fact, it is called jwara because it produces unhealthy effect in the body. No other disease is as frightful, complicated and difficult in treatment as this. That is why it is considered the king of all diseases. It is considered a life-giving force, since all living beings are born with fever (body temperature) and die with fever. It causes delirium. Afflicted living beings lose their memory of any event of their previous lives. In the end fever takes away the life of all creatures. [35]

Management of jwara

तत्र पूर्वरूपदर्शने ज्वरादौ वा हितं लघ्वशनमपतर्पणं वा, ज्वरस्यामाशयसमुत्थत्वात्;ततःकषायपानाभ्यङ्गस्नेहस्वेदप्रदेहपरिषेकानुलेपनवमनविरेचनास्थापनानुवासनोपशमननस्तःकर्म-धूपधूमपानाञ्जनक्षीरभोजनविधानं च यथास्वं युक्त्या प्रयोज्यम्||३६||

tatra pūrvarūpadarśane jwarādau vā hitaṁ laghvaśanamapatarpaṇaṁ vā,jwarasyāmāśayasamutthatvāt; tataḥ kaṣāyapānābhyaṅgasnehasvedapradehapariṣekānulepanavamanavirecanāsthāpanānuvāsanopaśamananastaḥkarmadhūpadhūmapānāñjanakṣīrabhojanavidhānaṁ ca yathāsvaṁ yuktyā prayojyam||36||

tatra pUrvarUpadarshane jvarAdau vA hitaM laghvashanamapatarpaNaM vA, jvarasyAmAshayasamutthatvAt; tataHkaShAyapAnAbhya~ggasnehasvedapradehapariShekAnulepanavamanavirecanAsthApanAnuvAsanopashamana-nastaHkarmadhUpadhUmapAnA~jjanakShIrabhojanavidhAnaM ca yathAsvaM yuktyA prayojyam||36||

When premonitory symptoms manifest or at the onset of the fever, dieting or fasting is useful because the disease originates from the amashaya. In such a case, intake of kashaya (decoctions), massage, oleation, fomentation, pradeha (sprinkling), anulepana (anointing with pastes), emesis, purgation, decoction and oily enema, pacificatory measures, snuffing, fumigation, smoking, collyrium, medicated milk and a specific dietetic regimen should be indicated as per the condition. [36]

Management of chronic jwara

जीर्णज्वरेषु तु सर्वेष्वेव सर्पिषः पानं प्रशस्यते यथास्वौषधसिद्धस्य; सर्पिर्हि स्नेहाद्वातं शमयति, संस्कारात् कफं, शैत्यात् पित्तमूष्माणं च; तस्माज्जीर्णज्वरेषु सर्वेष्वेव सर्पिर्हितमुदकमिवाग्निप्लुष्टेषु द्रव्येष्विति||३७||

भवन्ति चात्र- यथा प्रज्वलितं वेश्म परिषिञ्चन्ति वारिणा| नराः शान्तिमभिप्रेत्य तथा जीर्णज्वरे घृतम्||३८||

स्नेहाद्वातं शमयति, शैत्यात् पित्तं नियच्छति| घृतं तुल्यगुणं दोषं संस्कारात्तु जयेत् कफम्||३९||

नान्यः स्नेहस्तथा कश्चित् संस्कारमनुवर्तते| यथा सर्पिरतः सर्पिः सर्वस्नेहोत्तमं मतम्||४०||

JÍrṇajwareṣu tu sarveṣveva sarpiṣaḥ pānaṁ praśasyate yathāsvauṣadhasiddhasya; sarpirhi snehādvātaṁ śamayati,saṁskārāt kaphaṁ,śaityāt pittamūṣmāṇaṁ ca;tasmājjīrṇajwareṣu sarveṣveva sarpirhitamudakamivāgnipluṣṭeṣu dravyeṣviti||37||

Bhavanti cātra- yathā prajvalitaṁ veśma pariṣiñcanti vāriṇā. narāḥ śāntimabhipretya tathā jīrṇajware ghr̥taï||38||

snehādvātaṁ śamayati, śaityāt pittaṁ niyacchati| ghr̥taṁ tulyaguṇaṁ dōṣaṁ saṁskārāttu jayet kaphaï||39||

nānyaḥ snehastathā kaścit- saṁskāramanuvartate| yathā sarpirataḥ sarpiḥ sarvasnehottamaṁ matam||40||

jIrNajvareShu tu sarveShveva sarpiShaH pAnaM prashasyate yathAsvauShadhasiddhasya; sarpirhi snehAdvAtaM shamayati, saMskArAt kaphaM, shaityAtpittamUShmANaM ca; tasmAjjIrNajvareShu sarveShveva sarpirhitamudakamivAgnipluShTeShu dravyeShviti||37||

bhavanti cAtra- yathA prajvalitaM veshma pariShi~jcanti vAriNA| narAH shAntimabhipretya tathA jIrNajvare ghRutam||38||

snehAdvAtaM shamayati, shaityAt pittaM niyacchati| ghRutaM tulyaguNaM doShaM saMskArAttu jayet kapham||39||

nAnyaH snehastathA kashcit saMskAramanuvartate| yathA sarpirataH sarpiH sarvasnehottamaM matam||40||

In all types of jirna jwara (chronic fever), internal use of medicated ghee prepared is recommended. Medicated ghee pacifies vata by its unctuousness, kapha by (ghee infused with) kapha pacifying drugs, and pitta by its coldness. Therefore, ghee is useful in all forms of jirna jwara like fire subsides with water. [37]

Here are (the verses) –

As water is sprinkled on burning houses to douse (the fire), ghee is administered to manage chronic fever. No other sneha (oil etc.) brings the refinement properties of sanskara (processing with drugs) as ghee and therefore it is said the best one of all the snehas. [38-40]

गद्योक्तो यः पुनः श्लोकैरर्थः समनुगीयते| तद्व्यक्तिव्यवसायार्थं द्विरुक्तं तन्न गर्ह्यते||४१||

Gadyokto yaḥ punaḥ ślokairarthaḥ samanugīyate. tadvyaktivyavasāyārthaṁ dviruktaṁ tanna garhyate||41||

gadyokto yaH punaH shlokairarthaH samanugIyate| tadvyaktivyavasAyArthaM dviruktaM tanna garhyate||41||

This subject of jwara has been put here in prose and is again put into the form of verses. The intention is to make the subject clear and understandable. Such repetitions should not be dismissed in disgust. [41]

Summary

तत्र श्लोकाः-

त्रिविधं नामपर्यायैर्हेतुं पञ्चविधं गदम्| गदलक्षणपर्यायान् व्याधेः पञ्चविधं ग्रहम्||४२||

ज्वरमष्टविधं तस्य प्रकृष्टासन्नकारणम्| पूर्वरूपं च रूपं च भेषजं सङ्ग्रहेण च||४३||

व्याजहार ज्वरस्याग्रे निदाने विगतज्वरः| भगवानग्निवेशाय प्रणताय पुनर्वसुः||४४||

Tatra ślōkāḥ- trividhaṁ nāmaparyāyairhetuṁ pañcavidhaṁ gadam. gadalakṣaṇaparyāyān vyādheḥ pañcavidhaṁ graham||42||

jwaramaṣṭavidhaṁ tasya prakr̥ṣṭāsannakāraṇam. pūrvarūpaṁ ca rūpaṁ ca bheṣajaṁ saṅgraheṇa ca||43||

vyājahāra jwarasyāgre nidāne vigatajwaraḥ. bhagavānagniveśāya praṇatāya punarvasuḥ||44||

tatra shlokAH- trividhaM nAmaparyAyairhetuM pa~jcavidhaM gadam| gadalakShaNaparyAyAn vyAdheH pa~jcavidhaM graham||42||

jvaramaShTavidhaM tasya prakRuShTAsannakAraNam| pUrvarUpaM ca rUpaM ca bheShajaM sa~ggraheNa ca||43||

vyAjahAra jvarasyAgre nidAne vigatajvaraH| bhagavAnagniveshAya praNatAya punarvasuH||44||

To summarize,

Three types of nidana of jwara, along with their synonyms, five types of diseases, symptoms and synonyms of diseases, five means to know the diseases, eight types of fever, its distant and immediate causes, premonitory symptoms, symptoms and medicament in short – all these were expounded by Lord Punarvasu (Atreya) to Agnivesha in this first chapter on the diagnosis of jwara. [42-44]

Thus ends the first chapter on diagnosis of fever in Nidana Sthana in the treatise composed by Agnivesha and reducted by Charaka. (1)