Jwara Nidana – Madhava Nidana 2nd Chapter

Jwara Nidana -This is the second chapter of Madhava Nidana which deals with Jwara (fever)

दक्षापमानसंक्रुद्धरुद्रनिः श्वाससंभवः |
ज्वरो अष्टधा प्रुथग्द्वन्द्व संघातागन्तुजः स्मृतः || १||

dakshaapmaansankruddhrudrniah shvaasasambhvah |
jvaro ashtadhaa pruthgadvndva sanghaataagantujah smritah || 1||

Fever owes its origin to the exhalation of Rudra who got enraged consequent upon humiliation by Daksha. It is known to be of eight types, three, due to each of the three doshas separately, three due to their dual combinations, one due to all the three doshas combined while the eighth one due to exogenous factors.

मिथ्याहारविहाराभ्यां दोषा ह्यामाशयाश्रयाः |
बहिर्निरस्य कोष्टाग्निं ज्वरदाः स्यु रसानुगाः || २||

mithyaahaarvihaaraabhyaan dosaa hyaamaashyaashryaaah |
bhirnirsy kostaaganin jvrdaaah syu rsaanugaaaah || 2||

The doshas, provoked by the indulgence in improper foods and behavior, enter the Aamashaya and drive out the digestive fire from there. They follow the rasa dhatu and the chyle to spread all over the body and thus develop the fever.

Prodromal features of Fever —

स्वेदावरोधः संतापः सर्वाङ्गग्रहणं तथा |
युगपद्यत्र रोगे च स ज्वरो व्यपदिश्यते ||३||

svedaavrodhah santaapah sarvaanggagarhnn tthaa |
yugapdytra rogae cha sa jvaro vyapadishyate ||3||

Jwara is defined as the disease in which blockage to perspiration, rise of body temperature and pain all over the body exist together simultaneously.

श्रमो अरतिर्विवर्णत्वं वैरस्यं नयनप्लवः |
इच्छाद्वेषौ मुहुश्चापि शीतवातातपादिषु || ४||
जृम्भा अङ्गमर्दो गुरुता रोमहर्षो अरुचिस्तमः |
अप्रहर्षश्च शीतं च भवत्युत्पत्स्यति ज्वरे || ५||
(सामान्यतो विषेशात्तु जृम्भा अत्यर्थं समीरणात |
पित्तान्नयनयोर्दाहः कफादन्नारुचिर्भवेत् || ६ ||
रुपैरन्यतराभ्यां तु संसृष्तै द्वन्द्वजं विदुः |
सर्वलिङ्गसमवायः सर्वदोषप्रकोपजे || ७ ||)

shramo artirvivarnatvam vairsya nayanaplvah |
icchaadveshau muhushcaapi shitvaataatpaadishu || 4||
jrumbhaa angamardo gurutaa romharso aruchistmah |
apraharsshasch shitam cha bhvatyutptsyati jvare || 5||
(saamaanyto viseshaattu jrimbhaa atyartham samirnaat |
pittaannaynyordaahah kafaadannaaruchirbhavet || 6 ||
rupairanyatraabhyaan tu sansristai dvandvajn viduh |
sarvalinggasmvaayah srvdosprkopje || 7 ||)

• Shrama – Fatigue
• Arati – Restlessness
• Vivarnatvam – Discolouration of the skin
• Vairasyam – Bad taste in the mouth
• Nayana Plavah – eyes full of tears
• Alternate liking and disliking of cold foods, wind and sun
• Jrumbha – Yawning
• Anga marda – pressing or squeezing sensation in the body
• Guruta – heaviness
• Roma harsha – tingling sensation
• Aruchi – loss of taste perception
• Tamah – darkness
• Apraharsha – Displeasure
• Sheetam – cold touch are seen in individuals who are going to suffer from fever.

These are the general premonitory signs and symptoms of fever. Specifically,

• Over yawning is seen when Vata is predominant in the fever;
• Burning sensation in the eyes in the Pitta type.
• And in Kapha type fever there is no liking or lack of perception of taste in the food.

If any two of these three symptoms appear, the condition is identified as dual dosha affliction. When all these appear together, the disease (fever) is known as Tridoshaja, which is the one caused by the three doshas.

Signs and symptoms of the vata type of Jwara –

वेपथुर्विषमो वेगः कण्ठौष्टपरिशोषणं |
निद्रानाशः क्षवस्तंभो गात्राणां रौक्ष्यमेव च || ८ ||
शिरोह्रुद्गात्ररुग्वक्त्रवैरस्यं गाढ विट्कता |
शूलाध्माने जृम्भणं च भवन्त्यनिलजे ज्वरे || ९ ||

vepthurvismo vaah knthaustprishosnn |
nidraanaashah ksvstnbho gaaatraanaan rauksymev cha || 8 ||
shirohrudgaaatrrugavktrvairsyn gaaadh vitktaa |
shulaadhmaane jrimbhnn k bhvntynilje jvre || 9 ||

The features of Vataja Jwara that is the fever due to vitiation of vata dosha include the following –

• Vepathu – Shivering
• Vishama vega – non corresponding time of onset and exacerbation of fever
• कण्ठौष्टपरिशोषणं – severe dryness of throat and lips
• Nidra nasha – Loss of sleep
• Kshavastambha – Absence of sneezing
• Raukshya gatra – Roughness of the skin or decrease of moisture in the body
• Shiro hrud gatra ruk – pain in head, chest, and body
• Vaktra Vairasya – bad taste in the mouth
• Gadha Vitkata – hard and dry faeces
• Aadhmana – distension in abdomen
• Jrumbhanam – Too frequent yawning

Signs and symptoms of the Pitta type of Jwara –

वेगस्तीक्ष्णो अतिसारश्च निद्राल्पत्वं तथा वमिः |
कण्ठौष्टमुखनासानां पाकः स्वेदश्च जायते || १० ||
प्रलापो वक्त्रकटुता मूर्च्छा दाहो मदस्त्रुषा |
पीतविण्मूत्रनेत्रत्वं पैत्तिक भ्रम येव च || ११ ||

vegastiksno atisaarsch nidraalptvam tthaa vamih |
kanthaustmukhnaasaanaam paakah svedsch jaayate || 10 ||
pralaapo vaktrakatutaa murchaa daaho madstrushaa |
pitvinmutrnetratvam paittik bhrma yev cha || 11 ||

The following symptoms occur in fever due to pitta –

• Vega Teekshna – very high temperature
• Atisara – Diarrhoea
• Nidra Alpatvam – Loss of sleep
• Vami – Vomiting
• Kanta Aushta mukha nasa paka – Ulcers in the throat, lips, mouth, and nose
• Sweda – excessive perspiration
• Pralapa – delirium
• Vaktra katuta – acrid taste in the mouth
• Murccha – fainting
• Daha – burning sensation
• Mada – Inebriation
• Trusha – Thirst
• Peeta vin mutra netra – Yellowness of stools, urine and eyes
• Bhrama – disorientation

Signs and symptoms of Kapha type of Jwara —

स्तैमित्यं स्तिमितो वेग आलस्यं मधुरास्यता |
शुक्लमूत्रपुरीषत्वं स्तंभस्त्रुप्तिरथापि च || १२ ||
गौरवं शीतमुत्क्लेदो रोमहर्षो अतिनिद्रता |
[ स्रोतोरोधो रुगल्पत्वं प्रसेको लवणास्यता |
नात्युष्णगात्रता च्छर्दिर्लालास्रावो अविपाकता ||]
प्रतिश्यायो अरुचिः कासः कफजे अक्षणोश्च शुक्लता || १३ ||

staimityam stimito vega aalsyam madhuraasytaa |
shuklamutrapuristvam stambhstruptirthaapi cha || 12 ||
gaaurvam shitmutkledo romharsho atinidrataa |
[ srotorodho rugalptvn prseko lvnaasytaa |
naatyushngaaatrataa cchardirlaalaasraavo avipaakataa ||]
pratishyaayo aruchih kaasah kafaje akshnosch shukltaa || 13 ||

The signs and symptoms of Kaphaja Jwara include the symptoms such as –

• Staimitya – feeling of immobility in the body (that is being uninterested to move frequently)
• Stimita Vega – mild temperature
• Aalasyam – laziness
• Madhura aasyata – Sweet taste in the mouth
• Shukla mutra purisha – whitish colour of the urine and faeces
• Stambha – Rigidity
• Trupti – feeling of contentment (that is no urge of having food and drink)
• Gaurava – Heaviness
• Sheeta Utkleda – Feeling of cold
• Roma Harsha – Horripilation
• Ati nidrata – excessive sleeping
• Sroto rodha – Obstruction in the internal channels
• Praseka – formation of excessive salivation
• Lavana Aasyata – Salty taste in the mouth
• Na ati ushna gatra – mild temperature of the body
• Chardi – Vomiting
• Lala srava – Salivation
• Avipaka – Indigestion

Are the symptoms that are noticed in the case of kapha generated fever.

Similarly,

• Pratishyaya – Rhinitis
• Aruchi – Distaste
• Kasa – Cough
• Akshana Shukla – Whitish colour of the eyes are the other symptoms of this disease.

Signs and symptoms of Vata Pitta Type of Jwara –

तृष्णा मूर्च्छा भ्रमो दाहः स्वप्ननाशः शिरोरुजा |
कण्ठास्यशोषो वमथू रोमहर्षो अरुचिस्तमः || १४ ||
पर्वभेदश्च जृम्भा च वातपित्तज्वराकृतिः ||

Trushnaa Murccha bhramo dahah svapnanashah shirorujaa|
Kanthaasyashosho vamathu romaharsho aruchistamah || 14 ||
Parvabhedascha jrumbha cha vaatapittajvaraakrutih ||

The symptoms of Vata Pitta type of fever include these –

• Trushna – excessive thirst
• Murccha – Fainting
• Bhrama – disorientation
• Daaha – burning sensation
• Swapna nasha – loss of sleep
• Shiro ruja – headache
• Kanta Aasya shosha – dryness of throat
• Vamathu – vomiting
• Roma harsha – horripilation
• Aruchi – anorexia
• Tamah – feeling of darkness ahead the eyes
• Parva bheda – pain in the joints
• Jrumbha – yawning

Signs and symptoms of Vata sleshma type of jwara —

स्तैमित्यं पर्वणां भेदो निद्रा गौरवमेव च || १५ ||
शिरोग्रहः प्रतिश्यायः कासः स्वेदाप्रवर्तनं |
संतापो मध्यवेगश्च वातश्लेष्म ज्वराकृतिः || १६ ||

staimityam parvaanaam bhedo nidraa gauravameva cha || 15 ||
shirograhah pratishyayah kaasah ssvedaapravartanam |
santaapo madhyavegascha vaatashleshma jvaraakrutih || 16 ||

The signs and symptoms of Vata Shleshma type of jwara are –

• Staimitya — feeling of immobility in the body (that is being uninterested to move frequently)
• Parva Bheda – pain in the joints
• Nidra – excess sleep
• Gaurava – Heaviness
• Shiro graha – headache
• Pratishyaya – coryza
• Kasa – cough
• Sweda pravartanam – excessive perspiration
• Madhya Vega Santapa – moderate rise of temperature

Features of signs and symptoms of Sleshma Pitta type of Jwara —

लिप्ततिक्तास्यता तन्द्रा मोहः कासो अरुचिस्तृषा |
मुहुर्दाहो मुहुः शीतं श्लेष्मपित्तज्वराकृतिः || १७ ||

liptatiktaasytaa tandraa mohah kaaso aruchistrisaa |
muhurdaaho muhuh shitam shlesmapittajvraakritih || 17 ||

The features of Sleshma pitta type of fever include –

• Lipta tikta Aasya – sticky and bitter sensation in the mouth
• Tandra – drowsiness
• Moha – delusion
• Kasa – Cough
• Aruchi – Distaste
• Trusha – thirst
• Muhu daaha muhu sheeta – Alternative feeling of heat and cold in the body.

Signs and symptoms of Sannipata Jwara –

क्षणे दाहः क्षणे शीतमस्थिसन्धि शिरोरुजा |
सास्रावे कलुषे रक्ते निर्भुग्ने चापि लोचने || १८ ||
सस्वनौ सरुजौ कर्णौ कण्ठः शूकैरिवावृतः |
तन्द्रा मोहः प्रलापश्च कासः श्वासो अरुचिर्भ्रमः || १९ ||
परिदग्धा खरस्पर्शा जिह्वा स्रस्ताङ्गता परम् |
ष्ठीवनं रक्तपित्तस्य कफेनोन्मिश्रितस्य च || २० ||
शिरसो लोठनं तृष्णा निद्रानाशो हृदि व्यथा |
स्वेदमूत्रपुरिषाणां चिराद्दर्शनमल्पशः || २१ ||
कृशत्वं नातिगात्राणां प्रततं कण्ठकूजनं |
कोठानां श्यावरक्तानां मण्डलानां च दर्शनं || २२ ||
मूकत्वं स्रोतसां पाको गुरुत्वमुदरस्य च |
चिरात् पाकश्च दोषाणां सन्निपातज्वराकृतिः || २३ ||

kṣaṇe dāhaḥ kṣaṇe śītamasthisandhi śirorujā |
sāsrāve kaluṣe rakte nirbhugne cāpi locane || 18 ||
sasvanau sarujau karṇau kaṇṭhaḥ śūkairivāvrtaḥ |
tandrā mohaḥ pralāpaśca kāsaḥ śvāso arucirbhramaḥ || 19 ||
paridagdhā kharasparśā jihvā srastāṅgatā param |
ṣṭhīvanaṃ raktapittasya kaphenonmiśritasya ca || 20 ||
śiraso loṭhanaṃ trṣṇā nidrānāśo hrdi vyathā |
svedamūtrapuriṣāṇāṃ cirāddarśanamalpaśaḥ || 21 ||
krśatvaṃ nātigātrāṇāṃ pratataṃ kaṇṭhakūjanaṃ |
koṭhānāṃ śyāvaraktānāṃ maṇḍalānāṃ ca darśanaṃ || 22 ||
mūkatvaṃ srotasāṃ pāko gurutvamudarasya ca |
cirāt pākaśca doṣāṇāṃ sannipātajvarākrtiḥ || 23 ||

The features of Sannipatika (due to all the combined doshas) fever include the –

• Kshane daha kshane sheeta – feeling of hot and cold alternatively
• Asthi sandhi ruja – pain in the bones and joints
• Shiro ruja – Headache
• The patient has a dirty, red and sunken eyes with discharge
• Ear ache with tinnitus
• A sensation in the throat as If it is full of bristles
• Drowsiness
• Delusion
• Delirium
• Cough
• Difficult/ irregular respiration
• Loss of appetite
• Giddiness
• His tongue turns angry red at its edges and rough.
• There is weakness of the limbs
• And spitting of blood or else of a rusty sputum and bile
• Rolling on the head on the pillow
• Thirst
• Loss of sleep
• Pain in the heart (or the region of the heart)
• Elimination of small quantities of sweat, urine and faeces at long intervals
• Not much of wasting of the body.

Other features of the disease include the

• Continuous moaning (feeble sound in the throat)
• Appearance of dark red spots and patches on the skin
• Ulceration of the orifices of the body
• Feeling of the heaviness
• Dosha undergoing paaka (that is its returning to normalcy) very slowly.

दोषे विबद्धे नष्टे अग्नौ सर्वसम्पूर्ण लक्षणः ||
सन्निपात ज्वरो असाध्यः, कृच्छ्रसाध्यस्ततो अन्यथा || २४ ||

doṣe vibaddhe naṣṭe agnau sarvasampūrṇa lakṣaṇaḥ ||
sannipāta jvaro asādhyaḥ, krcchrasādhyastato anyathā || 24 ||

If the involved doshas are profound and deep seated, if the digestive capacity of the patient is completely diminished, and if all the features are found manifesting, such a case of sannipata jwara becomes incurable; otherwise, it is curable with difficulty.

(सप्तमे दिवसे प्राप्ते दशमे द्वादशो अपि वा |
पुनर्घोरतरो भूत्वा प्रशमं याति हन्ति वा || १||)

(सप्तमि द्विगुणा चैव नवम्येकादशी तथा |
येषा त्रिदोष मर्यादा मोक्षाय च वधाय च || २ ||)

(saptame divase prāpte daśame dvādaśo api vā |
punarghorataro bhūtvā praśamaṃ yāti hanti vā || 1||)

(saptami dviguṇā caiva navamyekādaśī tathā |
yeṣā tridoṣa maryādā mokṣāya ca vadhāya ca || 2 ||)

It has been noted that the sannipata fevers occurs in a periodic manner, depending on the causative factors involved. The sannipata fever factored mainly by vata would reappear gravely at the interval of days; the sannipata fever factored mainly by pitta would reappear gravely at the interval of 10 days. The sannipata fever factored mainly by kapha would reappear gravely at the interval of 12 days, after that the disease either gets pacified or it proves fatal.

Likewise, it has been observed that the vata dominated sannipata fever would continue upto 14 days, the pitta dominated sannipata fever would continue upto 18 days, and the kapha dominated sannipata fever would continue upto 22 days. These are the maximum limits of these diseases. Within these respective periods, the concerned sannipata fever either gets pacified or it kills the patient.

सन्निपातज्वरस्यान्ते कर्णमूले सुदारुणः |
शोथः संजायते तेन कश्चिदेव प्रमुच्यते || २५ ||

sannipātajvarasyānte karṇamūle sudāruṇaḥ |
śothaḥ saṃjāyate tena kaścideva pramucyate || 25 ||

At the final stage of the sannipataja jwara, sometimes there appears a profound swelling at the root of the ear. This is dreadful sign for only a few would recover from it.

अभिघाताभिचाराभ्यामभिशापाभिषङ्गतः |
आगन्तुर्जायते दोषैर्यथास्वं तं विभावयेत् || २६ ||

श्यावास्यता विषकृते तथा अतिसार एव च |
भक्तारुचिः पिपासा च तोदश्च सह मूर्च्छया || २७ ||

औषधिगन्धजे मूर्च्छा शिरो रुग्वमथुः क्षवः |
कामजे चित्तभ्रंशस्तन्द्रा आलस्यमभोजनम् || २८ ||

हृदये वेदना चास्य गात्रं च परिशुष्यति |

abhighātābhicārābhyāmabhiśāpābhiṣaṅgataḥ |
āganturjāyate doṣairyathāsvaṃ taṃ vibhāvayet || 26 ||

śyāvāsyatā viṣakrte tathā atisāra eva ca |
bhaktāruciḥ pipāsā ca todaśca saha mūrcchayā || 27 ||

auṣadhigandhaje mūrcchā śiro rugvamathuḥ kṣavaḥ |
kāmaje cittabhraṃśastandrā ālasyamabhojanam || 28 ||

hrdaye vedanā cāsya gātraṃ ca pariśuṣyati |

Abhighata (assault by weapons), Abhichara (sorcery and witchcraft), and abhishapas (microorganisms) generate aagantu jwaras. Even in such fevers, the features of doshas have to be recognized. The aagantu jvara (fever due to external factors) is caused by such factors as injury, witch craft, wrath of pious people and affliction of the evil. Based on the signs and symptoms, such fevers can be classified as oer the dosha classifications.

In aagantu jwara generated by poison, bluish discoloration of the mouth, diarrhea, loss of appetite, thirst, pain and fainting are seen; In fever generated by smell of plants (pollen of flowers and the like), fainting, headache, vomiting and sneezing are seen.

In kama jwara that is the fever caused by insatiable lust, such symptoms as instability of mind, drowsiness, laziness, distaste of food, pain in the heart and emaciation of the body are seen. Delirium occurs in fevers caused by fear and grief. Trembling is seen in fever caused by anger.

Fever caused by witchcraft and wrath of pious people features delusion and thirst while in fever that is resulted by affliction of evil spirits, the patient could be highly emotional and could indulge in non sense laughing, weeping and shivering (26 -29)

The dosha relation in the Aagantu jwara (Accidental fevers) –

काम शोक भयाद्वयुः, क्रोधात् पित्तं, त्रयो मलाः || ३० ||
भूताभिषङ्गात् कुप्यन्ति भूतसामान्यलक्षणाः |

kāma śoka bhayādvayuḥ, krodhāt pittaṃ, trayo malāḥ || 30 ||
bhūtābhiṣaṅgāt kupyanti bhūtasāmānyalakṣaṇāḥ |

Lust, grief and fear excite Vata while anger provokes pitta. Similarly, possession by evil spirits excites all the three doshas. Moreover, other symptoms and features also occur in these cases as per the specific dosha involved.

Onset of Vishama Jwara (Irregular fever) –

दोषो अल्पो अहित संभूतो ज्वरोत्सृष्टस्य वा पुनः || ३१ ||
धातुमन्यतमं प्राप्य करोति विषमज्वरम् |

doṣo alpo ahita saṃbhūto jvarotsrṣṭasya vā punaḥ || 31 ||
dhātumanyatamaṃ prāpya karoti viṣamajvaram |

The doshas that have undergone only a slight increase due to unsuitable eatables and activities, get lodged in other tissues (dhatus) and generate vishama jvara is irregular or intermittent fever. 31

Dhatu relationship of irregular fevers –

सन्ततं रसरक्तस्थः, सो अन्येध्युः पिशिताश्रितः || ३२ ||
मेदोगतस्तृतीये अह्नि , त्वस्थिमज्ज्जगतः पुनः |
कुर्यात् चतुर्थकं घोरमन्तकं रोग सङ्करं || ३३ ||

santataṃ rasaraktasthaḥ, so anyedhyuḥ piśitāśritaḥ || 32 ||
medogatastrtīye ahni , tvasthimajjjagataḥ punaḥ |
kuryāt caturthakaṃ ghoramantakaṃ roga saṅkaraṃ || 33 ||

Among the fevers referred to above, the santata jwara involves rasa and rakta dhatus , anyedushka jwara involves mams dhatu. The tritiyaka jwara involves medas. The chaturthaka jvara involves asthi and majja dhatus, which is a dreadful and fatal symptom. 32 -33

Time of bouts of irregular fever –

सप्ताहं वा दशाहं वा द्वादशाहमथापि वा |
संतत्या यो अविसर्गी स्यात् संततः स निगध्यते || ३४ ||
अहोरात्रे सततको द्वौ कालावनुवर्तते |
अन्येध्युष्कस्त्वाहोरात्र एककालं प्रवर्तते || ३५ ||
तृतीयाकस्तृतीये अह्नि चतुर्थे अह्नि चतुर्थकः |

saptāhaṃ vā daśāhaṃ vā dvādaśāhamathāpi vā |
saṃtatyā yo avisargī syāt saṃtataḥ sa nigadhyate || 34 ||
ahorātre satatako dvau kālāvanuvartate |
anyedhyuṣkastvāhorātra ekakālaṃ pravartate || 35 ||
trtīyākastrtīye ahni caturthe ahni caturthakaḥ |

Santata jwara is so named because, the fever continues without remission for seven, ten, twelve or even more days. In satata type of fever, there is a double rise of temperature in a period of 24 hours.

Similarly, in the case of the anyedyusha jwara it is only once in 24 hours. In the cases of the trtiyaka jvara, the rise of temperature takes place on alternate days while in the chaturthaka jvara it takes place on every fourth day.

केचिद् भुताभिषङ्गोत्थं ब्रुवते विषम ज्वरं || ३६ ||
kecid bhutābhiṣaṅgotthaṃ bruvate viṣama jvaraṃ || 36 ||

Some scholars opine that vishama jvaras or the intermittent fevers are due to bhutabhishanga.

कफ पित्तात्त्रिकग्राहि पृष्टाद्वात कफात्मकः |
वात पित्ताच्छिरोग्राही त्रिविधः स्यात् तृतीयकः || ३७ ||

kapha pittāttrikagrāhi prṣṭādvāta kaphātmakaḥ |
vāta pittācchirogrāhī trividhaḥ syāt trtīyakaḥ || 37 ||

The tritiyaka fever has been noticed as to have three variations. (1) If kapha and pitta are vitiated this fever starts with severe pain in the lower portion of the back; (2) if Vata and kapha are vitiated, the fever starts with pain in the upper portion of the back while; (3) if vata and pitta are vitiated the tertian fever starts with pain in the head. 37

चतुर्थको दर्शयति प्रभावं द्विविधं ज्वरः |
जङ्घाभ्यां श्लेष्मिकः पूर्वं शिरस्तो अनिल संभवः || ३८ ||
caturthako darśayati prabhāvaṃ dvividhaṃ jvaraḥ |
jaṅghābhyāṃ śleṣmikaḥ pūrvaṃ śirasto anila saṃbhavaḥ || 38 ||

The so named Chaturthaka fever also manifests in two ways, (1) if kapha is vitiated this fever starts with pain in the calf muscles and (2) if vata is complicated the head is affected with pain.

Chaturthaka viparyaya (Reversal of quartan fever)

विषम ज्वर एवान्यश्चतुर्थक विपर्ययः |
स मध्ये ज्वरयत्यह्नि ह्यादावन्ते च मुञ्चति || ३९ ||

viṣama jvara evānyaścaturthaka viparyayaḥ |
sa madhye jvarayatyahni hyādāvante ca muñcati || 39 ||

There is yet another kind of vishama jwara. It is known as chaturthaka viparyaya. In the case of this disease, fever is not experienced on the first and the fourth day but there is on the two days in the middle. 39

Vatabalasaka Fever –

नित्यं मन्दज्वरो रूक्षः शूनकस्तेन सीदति |
स्तब्धाङ्ग श्लेष्मभूयिष्टो बवेद्वात बलासकी || ४० ||

nityaṃ mandajvaro rūkṣaḥ śūnakastena sīdati |
stabdhāṅga śleṣmabhūyiṣṭo bavedvāta balāsakī || 40 ||

The Vatabalasaka jwara is generated by morbid increase of kapha. It manifests as mild fever occurring daily with dryness, oedema, debility, and feeling of stiffness of the body.

Pralepaka Fever –

प्रलिम्पन्निव गात्राणि घर्मेण गौरवेण च |
मन्दज्वरविलेपी च सशीतः स्यात् प्रलेपकः || ४१ ||

pralimpanniva gātrāṇi gharmeṇa gauraveṇa ca |
mandajvaravilepī ca saśītaḥ syāt pralepakaḥ || 41 ||

When the patient feels as if he has been covered with sweat, has heaviness in the body along with a low degree fever and a sensation of coldness, he is suffering from the fever that has been identified as pralepaka. 41

Fevers where half of the body is afflicted by temperature –

विदग्धे अन्नरसे देहे श्लेष्मपित्ते व्यवस्थिते |
तेनार्धं शीतलं देहमर्धमुष्णं प्रजायते || ४२ ||

vidagdhe annarase dehe śleṣmapitte vyavasthite |
tenārdhaṃ śītalaṃ dehamardhamuṣṇaṃ prajāyate || 42 ||

If the annarasa that is the nutrient portion of the food gets vidagdha or overcooked due to morbid increase of pitta during the process of digestion, there manifests a fever in which only one half of the body turns warm while the other half remains cold. 42

काये दुष्टं यदा पित्तं श्लेष्मा चान्ते व्यवस्थितः |
तेनोष्णत्वं शरीरस्य शीतत्वं हस्तपादयोः || ४३ ||

kāye duṣṭaṃ yadā pittaṃ śleṣmā cānte vyavasthitaḥ |
tenoṣṇatvaṃ śarīrasya śītatvaṃ hastapādayoḥ || 43 ||

When pitta is vitiated in the trunk followed by the kapha that has been vitiated and dislodged in the extremities, then manifests a fever in which the trunk of the patient remains warm while his extremities
are cold. 43

Shitapurva (starting with cold) and Dahapurva (starting with burning sensation) fevers –

काये श्लेष्मा यदा दुष्टः पित्तं चान्ते व्यवस्थितम् |
शीतत्वं तेन गात्राणामुष्णत्वं हस्तपादयोः || ४४ ||

त्वक्स्थौ श्लेष्मानिलौ शीतमादौ जनयतो ज्वरे |
तयोः प्रशान्तयोः पित्तमन्ते दाहं करोति च || ४५ ||

करोत्यादौ तथा पित्तं त्वक्स्थं दाहमतीव च |
तस्मिन् प्रशान्ते त्वितरौ कुरुतः शीतमन्ततः || ४६ ||

द्वावेतौ दाहशीतादिज्वरौ संसर्गजौ स्मृतौ |
दाह पूर्वस्तयोः कष्टः कृच्छ्रसाध्यतमश्च || ४७ ||

kāye śleṣmā yadā duṣṭaḥ pittaṃ cānte vyavasthitam |
śītatvaṃ tena gātrāṇāmuṣṇatvaṃ hastapādayoḥ || 44 |

tvaksthau śleṣmānilau śītamādau janayato jvare |
tayoḥ praśāntayoḥ pittamante dāhaṃ karoti ca || 45 ||

karotyādau tathā pittaṃ tvaksthaṃ dāhamatīva ca |
tasmin praśānte tvitarau kurutaḥ śītamantataḥ || 46 ||

dvāvetau dāhaśītādijvarau saṃsargajau smrtau |
dāha pūrvastayoḥ kaṣṭaḥ krcchrasādhyatamaśca || 47 ||

When kapha is vitiated in the trunk after pitta has been vitiated and located in the extremities, fever manifests with the trunk being cold and the extremities warm.

When the vitiated kapha and vata are lodged in the skin, they generate fever preceded by cold rigors where after the pitta turns the body warm. When the pitta lodged in the skin produces fever first, the other two doshas make the body cold. These two types of fevers daahapurva (the one preceded by heat) and shitapurva (the one preceded by feeling of cold) are generated by the combination of two doshas. The dahapurva type of fever is a troublesome disease and is very difficult to cure.

Dhatu (tissue) based fevers –
Rasaja Jwara —

गुरुता ह्रुदयोत्क्लेशः सदनं च्छर्ध्यरोचकौ |
रसस्थे तु ज्वरे लिङ्गं दैन्यं चास्योपजायते || ४८ ||

gurutā hrudayotkleśaḥ sadanaṃ cchardhyarocakau |
rasasthe tu jvare liṅgaṃ dainyaṃ cāsyopajāyate || 48 ||

If the jwara (fever) is lodged in the blood plasma (rasa dhatu), it manifests with a feeling of heaviness in the body, nausea, debility, vomiting, loss of appetite and a feeling of helplessness. 48

Raktaja Jwara —

रक्त निष्टीवनं दाहो मोहश्चच्छर्दन विभ्रमौ |
प्रलापः पिडका तृष्णा रक्तप्राप्ते ज्वरे नृणाम् || ४९ ||

rakta niṣṭīvanaṃ dāho mohaścacchardana vibhramau |
pralāpaḥ piḍakā trṣṇā raktaprāpte jvare nrṇām || 49 ||

If the fever is lodged in the blood (rakta), the following symptoms emerge: haemoptysis, burning sensation, delusion, vomiting, giddiness and delirium. Moreover there appear rashes or small boils on skin and thirst.

Mamsaja Jwara —

पिण्डीकोद्वेष्तनं तृष्णा सृष्टमूत्र पुरिषता |
उष्मा अन्तर्दाह विक्षेपौ ग्लानिः स्यान्मांसगे ज्वरे || ५० ||

piṇḍīkodveṣtanaṃ trṣṇā srṣṭamūtra puriṣatā |
uṣmā antardāha vikṣepau glāniḥ syānmāṃsage jvare ||

If the fever gets lodged in the mamsadhatu (muscular tissue), the following symptoms emerge:

• Pindikodvesthanam – pain in the calves
• Trushnaa – thirst
• Srushta mutra purisha – frequent passing of urine and stools
• Ushma – high temperature
• Antar daha – burning sensation inside
• Vikshepa – unnecessary and involuntary movements of the hands and feet and
• Glaani – exhaustion.

Medasaja Jwara —

भृशं स्वेदस्तृषा मूर्च्छा प्रलापः च्छर्दिरेव च |
दौर्गन्ध्यारोचकौ ग्लानिर्मेदःस्थे चा सहिष्णुता || ५१ ||

bhrśaṃ svedastrṣā mūrcchā pralāpaḥ cchardireva ca |
daurgandhyārocakau glānirmedaḥsthe cā sahiṣṇutā || 51||

If the fever is lodged in the medas dhatu (adipose tissue), the following symptoms emerge:

• Sweda – profuse sweating
• Trushna – thirst
• Murrcha – fainting
• Pralapa – delirium
• Chardi – vomiting
• Daurgandhya – bad smell of the body
• Arochaka – loss of appetite
• Glaani – exhaustion
• Asahishnuta – intolerance

Asthija Jwara —

भेदो अस्थ्नां कूजनं विरेकश्च्छर्दिरेव च |
विक्षेपणं च गात्राणामेतदस्थिगते ज्वरे || ५२ ||

bhedo asthnāṃ kūjanaṃ virekaścchardireva ca |
vikṣepaṇaṃ ca gātrāṇāmetadasthigate jvare || 52 ||

If the fever is lodged in the bone tissue (asthi dhatu), the following symptoms emerge:

• Asthano Bheda – splitting pain in the bones
• Kujana – low sound from the throat (moaning)
• Shwasa – promoted respiration
• Vireka – diarrhea
• Chardi – vomiting
• Vikshepa – Involuntary movements of the hands and feet. 52

Majja Jwara —

तमःप्रवेशनं हिक्का कासः शैत्यं वमिस्तथा |
अन्तर्दाहो महाश्वासो मर्मच्छेदश्च मज्जगे || ५३ ||

tamaḥpraveśanaṃ hikkā kāsaḥ śaityaṃ vamistathā |
antardāho mahāśvāso marmacchedaśca majjage || 53 ||

If the fever is lodged in the bone marrow (majjadhatu), the following symptoms might emerge:

• Tamah Praveshanam – appearance of darkness before the eyes
• Hikka – Hiccup
• Kasa – cough
• Shaitya – Cold feeling
• Vami – Vomiting
• Antar daha – Burning sensation within the body
• Maha Shwasa – Greatly promoted respiration
• Marma Ccheda Majja – a cutting type of pain in the heart and other vital spots of the body. 53

Shukraja Jwara —

मरणं प्राप्नुयात् तत्र शुक्रस्थानगते ज्वरे |
शेफसः स्तब्धता मोक्षः शुक्रस्य तु विशेषतः || ५४ ||

maraṇaṃ prāpnuyāt tatra śukrasthānagate jvare |
śephasaḥ stabdhatā mokṣaḥ śukrasya tu viśeṣataḥ || 54 ||

If the fever is lodged in the reproductive tissues (shukra dhatu), death appears, preceded by constant erection of the penis and profuse discharge of semen. 54

Prakrta Jwara —

वर्षा शरद्वसन्तेषु वातध्यैः प्राकृतः क्रमात् |
वैकृतो अन्यो स दुःसाध्यः प्राकृतश्चानिलोद्भवः || ५५ ||

varṣā śaradvasanteṣu vātadhyaiḥ prākrtaḥ kramāt |
vaikrto anyo sa duḥsādhyaḥ prākrtaścānilodbhavaḥ || 55 ||

The fever that occurs in a certain season is called Prakrta jwara. For example, the vata jwara in the Varsha season, Pitta jvara in the Sharad season and kapha jwara in the vasanta season are natural fevers. Other fevers are vaikrta (unnatural) and they are difficult to cure. Moreover, the natural one caused by Vata is also not easy to cure. 55

वर्षासु मारुतो दुष्टः पित्त – श्लेष्मान्वितो ज्वरम् |
कुर्यात्, पित्तं च शरदि तस्य चानुबलः कफः || ५६ ||
तत्प्रकृत्या विसर्गाच्च तत्र नानशनाद्भयम् |
कफो वसन्ते तमपि वातपित्तं भवेदनु || ५७ ||

varṣāsu māruto duṣṭaḥ pitta – śleṣmānvito jvaram |
kuryāt, pittaṃ ca śaradi tasya cānubalaḥ kaphaḥ || 56||
tatprakrtyā visargācca tatra nānaśanādbhayam |
kapho vasante tamapi vātapittaṃ bhavedanu || 57 ||

In the Varsha rutu (rainy season) vata gets vitiated and generates fever which is characterized by provocation of both pitta and kapha; In the sharad rutu (autumn) the pitta generates fever and is subsequently helped by kapha, so there is no harm even if the patient does not take any food. The kapha generates fever in the vasanta rtu (spring season) and is subsequently supported by vata and pitta. 56-57

निदानोक्तानुपशयो विपरितोपशायिता || ५८ ||

nidānoktānupaśayo viparitopaśāyitā || 58 ||

Similarly, such factors that tend to promote the particular dosha also bring about increase fever, whereas the opposites of it actuate the fever. 58

Internal and external fevers —

अन्तर्दाहो अधिकस्तृष्णा प्रलापः श्वसनं भ्रमः |
संध्यस्थिशूलमस्वेदो दोष वर्चोविनिग्रहः || ५९ ||
अन्तर्वेगस्य लिङ्गानि ज्वरस्यैतानि लक्षयेत् |
संतापो ह्यधिको बाह्यस्तृष्णादीनां च मार्दवं || ६० ||
बहिर्वेगस्य लिङ्गानि सुखसाध्यत्वमेव च |

antardāho adhikastrṣṇā pralāpaḥ śvasanaṃ bhramaḥ |
saṃdhyasthiśūlamasvedo doṣa varcovinigrahaḥ || 59 ||
antarvegasya liṅgāni jvarasyaitāni lakṣayet |
saṃtāpo hyadhiko bāhyastrṣṇādīnāṃ ca mārdavaṃ || 60 ||
bahirvegasya liṅgāni sukhasādhyatvameva ca |

Fever is considered antarvega when manifesting inside the body predominantly it demonstrate the following features:

• Antardaha – Feeling of burning sensation inside.
• Adhika Trushna – too much of thirst
• Pralapa – Delirium
• Shwasanam – difficult respiration
• Bhrama – Giddiness
• Sandhi asthi shoola – Pain in the joints and bones
• Asweda – Absence of perspiration
• Dosha varcha vinigrahah – non elimination of doshas and faeces.

On the other hand, when the fever is manifesting with very high temperature externally, but thirst and other features are mild, this situation is considered bahirvega (residing and manifesting externally). This situation is easy to cure. 59 – 60

Aama (Undigested), Pachyamana (digesting) and Nirama (digested) fevers —

लालाप्रसेको ह्रुल्लास – हृदयाशुद्ध्यरोचकाः || ६१ ||
तन्द्रालस्याविपाकास्यवैरस्यं गुरुगात्रता |
क्षुन्नाशो बहुमूत्रत्वं स्तब्धता बलवाञ्ज्वरः || ६२ ||
आमज्वरस्य लिङ्गानि, न दध्यात्तत्र भेषजम् |
भेषजं ह्यामदोषस्य भूयो ज्वलयति ज्वरम् || ६३ ||
(शोधनं, शमनीयं च करोति विषमज्वरम् )

lālāpraseko hrullāsa – hrdayāśuddhyarocakāḥ || 61 ||
tandrālasyāvipākāsyavairasyaṃ gurugātratā |
kṣunnāśo bahumūtratvaṃ stabdhatā balavāñjvaraḥ || 62 ||
āmajvarasya liṅgāni, na dadhyāttatra bheṣajam |
bheṣajaṃ hyāmadoṣasya bhūyo jvalayati jvaram || 63 ||
(śodhanaṃ, śamanīyaṃ ca karoti viṣamajvaram )

The features of the Aama Jwara that is the fever caused by doshas that have association of Aama (Undigested food) –

• Lala Praseka – Profuse production of the saliva
• Hrullasa – Nausea
• Hrudaya shuddha – feeling of heaviness in the heart
• Arochaka – anorexia
• Tandra – drowsiness
• Aalasya – Lassitude
• Avipaka – indigestion
• Aasya Vairasya – distaste
• Guru gatrata – heaviness in the body
• Kshunaasho – Loss of appetite
• Bahu Mutrata – Excessive urination
• Stabdhata – rigidity in the limbs
• Balavan Jvarah – Strong fever

One should not opt for medicine in such condition as the medicine itself could induce more fever.

Features of Pachyamana (digesting) Jwara –

• Jvalayati jvaram – Temperature
• Excessive thirst
• Delirium
• Dyspnea
• Giddiness
• Passing of faeces and
• Vomiting sensation

The features of Nirama (digested) Jwara include such symptoms as

• Agitated Appetite
• Weakness
• Lightness of the body
• Less temperature
• Outward movement of the doshas. 61 – 63

Pachyamana Jwara —

ज्वरवेगो अधिकस्तृष्णा प्रलापः श्वसनं भ्रमः |
मल प्रवृत्तिरुत्क्लेशः पच्यमानस्य लक्षणम् || ६४ ||

jvaravego adhikastrṣṇā pralāpaḥ śvasanaṃ bhramaḥ |
mala pravrttirutkleśaḥ pacyamānasya lakṣaṇam || 64 ||

Fever is considered to be pachyamana (in the stage of ripening or intermediary stage) if features like Increase of temperature, severe thirst, delirium, difficult respiration, giddiness, frequent elimination of faeces and nausea are manifested. 64

Nirama Jwara —

क्षुत् क्षामता लघुत्वं च गात्राणां ज्वर मार्दवं |
दोष प्रवृत्तिरष्टाहो निरामज्वर लक्षणम् || ६५ ||

kṣut kṣāmatā laghutvaṃ ca gātrāṇāṃ jvara mārdavaṃ |
doṣa pravrttiraṣṭāho nirāmajvara lakṣaṇam || 65 ||

The features of Nirama Jwara that is fully ripe or the terminal stage of fever include

• Kshut – Appearance of hunger
• Kshamata – Slight emaciation
• Laghuta – Feeling of lightness of the body
• Jvara Mardavam – Decreasing temperature
• Dosha Pravrutti – elimination of the doshas as well as Faeces, urine and the like.
  This fever continues for eight days.

Curability of fever –

बलवत्स्वल्पदोषेषु ज्वरः साध्यो अनुपद्रवः |

balavatsvalpadoṣeṣu jvaraḥ sādhyo anupadravaḥ |

Fever affecting persons of strong physique, characterized by mild increase, and having no implications is easily curable.

Incurability of fever —

हेतुभिर्बहुभिर्जातो बलिभिर्बहुलक्षणः || ६६||
ज्वरः प्राणान्तकृध्याश्च शीघ्रमिन्द्रियनाशनः |

hetubhirbahubhirjāto balibhirbahulakṣaṇaḥ || 66||
jvaraḥ prāṇāntakrdhyāśca śīghramindriyanāśanaḥ |

Fevers generated by several and powerful causes, manifesting with several powerful features that destroy the faculties are difficult to control. 66

ज्वरः क्षीणस्य शूनस्य गम्भीरो दैर्घरात्रिकाः || ६७ ||
असाध्यो बलवान् यश्च केशसीमन्तकृज्ज्वरः |

jvaraḥ kṣīṇasya śūnasya gambhīro dairgharātrikāḥ || 67 ||
asādhyo balavān yaśca keśasīmantakrjjvaraḥ |

Fever affecting persons who are weak, which generate oedema all over the body, which are deep seated in the tissues and which continue for long periods and those causing furrows in between the hairs of the head – all are difficult to treat. They could be even incurable. 67

Gambhira Jwara —

गम्भीरस्तु ज्वरो ज्ञेयो ह्यन्तर्दाहेन तृष्णया || ६८ ||
आनद्धत्वेन चात्यर्थं श्वास कासोद्रमेन च |

gambhīrastu jvaro jñeyo hyantardāhena trṣṇayā || 68 ||
ānaddhatvena cātyarthaṃ śvāsa kāsodramena ca |

A gambhira jwara is identified with burning sensation inside the body, thirst, severe distension of abdomen, increase respiration, and cough. 68

आरम्भाद्विशमो यस्तु यश्च वा दैर्घरात्रिकः || ६९ ||
क्षीणस्य चातिरुक्षस्य गम्भीरो यस्य हन्ति तम् |
विसञ्ज्ञस्ताम्यते यस्तु शेते निपतितो अपि वा || ७० ||

ārambhādviśamo yastu yaśca vā dairgharātrikaḥ || 69 ||
kṣīṇasya cātirukṣasya gambhīro yasya hanti tam |
visañjñastāmyate yastu śete nipatito api vā || 70 ||

Fever which is irregular even since its commencement, which is continuing for long periods, which affects the weak and which is very dry is serious. If one loses his senses, lies down or falls down frequently and suffers from outward cold and inner burning sensation of the body, he will die with fever.

शीतार्दितो अन्तरुष्णश्च ज्वरेण म्रियते नरः |
यो हृष्टरोमा रक्ताक्षो हृदि संघाता शूलवान || ७१ ||
वक्त्रेण चैवोच्छवसिति तं ज्वरो हन्ति मानवम् |
हिक्का श्वास तृषायुक्तं मूढं विभ्रान्तलोचनम् || ७२ ||
संततोच्छवासिनं क्षीणं नरं क्षपयति ज्वरः |
हतप्रभेन्द्रियं क्षीणमरोचक निपीडितम् || ७३ ||
गम्भीरतीक्ष्णवेगार्तं ज्वरितं परिवर्जयेत् |

śītārdito antaruṣṇaśca jvareṇa mriyate naraḥ |
yo hrṣṭaromā raktākṣo hrdi saṃghātā śūlavāna || 71 ||
vaktreṇa caivocchavasiti taṃ jvaro hanti mānavam |
hikkā śvāsa trṣāyuktaṃ mūḍhaṃ vibhrāntalocanam || 72 ||
saṃtatocchavāsinaṃ kṣīṇaṃ naraṃ kṣapayati jvaraḥ |
hataprabhendriyaṃ kṣīṇamarocaka nipīḍitam || 73 ||
gambhīratīkṣṇavegārtaṃ jvaritaṃ parivarjayet |

If one suffers from horripilation, redness in the eyes, heavy pain in the heart, and breathes through the mouth, the fever destroys him. The fever emaciates that individual who has hiccup, dyspnea, Thirst, senselessness, terrified looks, continuous heavy breath, and weakness.

Treatment should be given up if the patient of fever has lost lustre of the body as well as perception by the sense organs, has got emaciated, has anorexia and has markedly sharp rise of temperature (as he is incurable) 71 – 73

Premonitory Symptoms of relief of fever –

दाहः स्वेदो भ्रमस्तृष्णा कम्प – विड्भीद संज्ञता |
कूजनम् चास्यवैगन्ध्यमाकृतिर्ज्वरमोक्षणे || ७४ ||

dāhaḥ svedo bhramastrṣṇā kampa – viḍbhīda saṃjñatā |
kūjanam cāsyavaigandhyamākrtirjvaramokṣaṇe || 74 ||

The features of the fever that is subsiding –

• Daha – Burning sensation
• Swedo – perspiration
• Bhrama – Giddiness
• Trushnaa – thirst
• Kampa – tremors
• Vid bheda – elimination of faeces
• Kujana – Moaning
• Aasya Vaigandhya – Bad smell from the mouth

Signs and symptoms on relief of fever –

स्वेदो लघुत्वं शिरसः कण्डुः पाको मुखस्य च |
क्षवथुश्चान्नलिप्सा च ज्वरमुक्तस्य लक्षणम् || ७५ ||

svedo laghutvaṃ śirasaḥ kaṇḍuḥ pāko mukhasya ca |
kṣavathuścānnalipsā ca jvaramuktasya lakṣaṇam || 75 ||

Features of the person relieved of the fever –

• Swedo — Perspiration
• Laghutvam — feeling of lightness of body
• Shirasah Kandu — Itching of the head
• Mukha Paka — Appearance of ulcers in the mouth
• Kshvathu — Sneezing
• Anna Lipsa — Desire for eatables

Thus concludes the Chapter on Jwara