🔘 Jwara

JWARA ROGA :-

INTRODUCTION:-

- Jwara in general terms can be translated as fever.

- Jwara occurs in humans due to eight causative factors, - vata, pitta, kapha, vata-pitta, vata-kapha, pitta-kapha,vata-pitta-kapha, and agantuja.

SYNONYMS:-

- Jwara

- Vikara

- Roga

- Vyadhi

- Atanka

CLASSIFICATION OF JWARA:-

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

1. Sharira (Physical) and Manasa (mental)

2. Saumya (caused by cold) and Agneya (caused by heat).

3. Antarvega (internal) and Bahirvega (external)

4. Prakruta (natural, seasonal) and Vaikruta (Unseasonal) 

5. Sadhya (curable) and Asadhya (incurable).

- Jwara is alsoclassified into 5 categories depending upon the strength and weakness of Doshas and the time. These are also known as vishama jwara:- 

Satata, Santata, Anyedyuska, Trtiyaka and Chaturthaka.

- Depending upon the Ashraya (site of manifestation) in the 7 Dhatus (basic tissue elements), Jwara is also classified into 7 categories:- Rasagata, Raktagata, Mamsagata, Medogata, Asthigata, Majjagata and Shukragata Jwara.

- There are mainly 8types of jwara:- Vataja, Pittaja, Kaphaja, Vata-pittaja, Vata-Kaphaja, Pitta-Kaphaja, Sannipataja and Agantuja.

- Agantuja jwara is of 4types:- Abhighataja,Abhicharaka, Abhishangaja, Abhishapaja

NIDANA PANCHAKA:-

1.Nidana

2.Purvaroopa

3.Roopa

4.Upashaya-Anupashaya

5.Samprapti

NIDANA:-

- Mithya ahara Vihara

- Nija and agantuja karana

PURVAROOPA:-

- Alasyam(lethargy)

- Excessive lacrimation

- Jrambhana

- Gauravam

- Klama (Mental fatigue)

- Jwalana, Aatapa, Vayu and Ambu Bhakti Dwesha (Uncertainty about liking and disliking for fire, sun, wind and water)

- Avipaka (Indigestion)

- Vairasya (Anorexia)

- Bala Hani Depletion in strength and complexion) 

ROOPA:-

- Deha Santapa

- Mana santapa

SAMPRAPTI:-

-Mithya ahara vihara – pittapradhana tridosha prakopa – doshasanchaya in amashaya – koshthagni bahirgamana – Santapa – Jwara

TYPES:-

1. Vataja Jwara:-

- Nidana:-

• 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  and causes vataja jwara.

- Samprapti:-

• 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. 

- Lakshana:-

• 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.

• 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. 

• There is 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. 

2. Pittaja jwara:-

- Nidana:-

• 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 causes pittaja jwara.

- Samprapti:-

• 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 agni gets 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.

- Lakshana:-

• 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

3. Kaphaja Jwara:-

- Nidana:-

• Excessive use of unctuous, heavy, sweet, slimy, cold, sour, salty substances, day sleep, joy and a sedentary lifestyle causes kaphaja jwara.

- Samprapti:-

• The vitiated kapha enters 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.

- Lakshana:-

• 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.

4. Vata-pittaja jwara:-

- Lakshana:-

• Headache, pain in joints, horripilation, dryness of throat and mouth, sleeplessness, daha,chhardi,trushna,murchha,bhrama .

5. Vata-Kaphaja jwara:-

- Lakshana:-

• Mild increase in temperature, feeling of coldness, feeling of covered with wet cloth, Gaurava, tandra, Pratishyaya and kasa.

6. Pitta-Kaphaja jwara:-

- Lakshana:-

• Frequent alternative feeling of burning sensation or coldness, sometimes sweating or sometimes arrest of sweating, coating and bitter taste in mouth, tandea, kasa, aruchi, trushna.

7. Sannipatika jwara:-

- Nidana:-

• 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 

o 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). It shows the symptoms of all tridoshas. 

o Sannipataja jwara has further 13types.

OTHER TYPES:-

- Sharirika and manasika jwara:-

1. Sharirika jwara:- If jwara manifests the body first , due to affliction of sharirika dosha. Tapa to the body produces anorexia, thirst,bodyache and absence of perspiration.

2. Manasika jwara:- Manifests in the mind first ,due to affliction of manasika dosha. Tapa to the mind produces mental distraction, restlessness,glani etc.

- Saumya and agneya jwara:-

1. Saumya jwara:- Jwara produced by vata kapha is sheeta or saumya jwara. Desires for hot things.

2. Agneya jwara:- Jwara produced by vata pitta is ushna or agneya jwara. Desires for cold things.

- Antarvega and bahirvega jwara:-

1. Antarvega jwara:- Charecterised by antardaha, atitrushna, pralapa, shwasa, bhrama,sandhishoola, aswesa and non elimination of dosha and mala.

2. Bahirvega jwara:- Charecterised by excessive temprature in the exterior parts of the body,trishna etc.

- Prakruta and vaikruta jwara:-

1. Prakruta jwara:- The jwara manifested in the particular season that is responsible for vitiation of involved dosha is called as Prakruta jwara.

2. Vaikruta jwara:- Jwara manifests in season other tgan that responsible for vitiation of the concerned dosha is known as vaikruta jwara

- Sadhya and Asadhya jwara:-

1. Sadhya jwara:- In case of balawana roga, alpa dosha avastha and no complications it is curable or sadhya.

2. Asadhya jwara:- Following factors indicates incurability of jwara:-

• Jwara due to many nidanas.

• Many signs and sympotoms

• Quick distruction of sense organs

• If jwara associated with delirium,giddiness or breathlessness pt. dies either on 7th day,10th day or 12th day.

• Weak patient and deep seated jwara etc.

- Agantuja jwara:-

1. Abhighataja jwara:- 

• Nidana:- Due to trauma of weapon,stone,hunter, fist, wood stick etc. Vata gets aggrivated and vitiates rakta resulting in the manifestation of Abhighataja jwara.

• Lakshana:- Distress, swelling, discoloration and pain

2. Abhicharaja jwara:-

• Nidana:- Jwara caused by evil tantric rituals or chanting mantras is called abhicharaja jwara.

• Lakshana:- Sannipataja jwara lakshana along with affliction of mind,sense organs and body

3. Abhishapaja jwara:- 

• Nidana:- Jwara caused by cursing of the saints is called Abhishapaja jwara.

• Lakshana:- Sannipataja jwara lakshana along with affliction of mind,sense organs and body

4. Abhishangaja jwara:-

• Nidana:- Due to kama,krodha,bhaya and shoka vata gets aggrivated which manifests jwara. 

• Due to bhuta preta pishacha all the tridoshas gets aggrivated which manifest jwara

• Contact with vishavriksha and visha anila can also manifest this jwara.

• Lakshana:- 

a. Kamajwara:- Dhyana, tachypnea

b. Krodhajwara:- red eyes and face etc.

c. Bhaya jwara:- Trasa

d. Shokajwara:- Lacrimation

e. Bhutaveshajanya jwara:- Amanusha

f. Vishaja jwara:- Murchha,moha,mada,glani

- Dhatugata jwara:-

1. Rasadhatugata- Gauravta, Dainyata, sadana, Anambra, chhardi, arochaka

2. Raktadhatugata:- Pidaka, raktasthivana, trishna, daha,raga,bhrama,mada.

3. Mamsadhatugata:- Antardaha, gatravikshepa, Daurgandhya, shrushtavita, trushna,moha and glani.

4. Medadhatugata:- Atisweda, Swagandha asahatva, trushna,pralapa and chhardi

5. Asthidhatugata:- Asthibheda, gatra vikshepa, kantgakujana,atisara, chhardi

6. Majjadhatugata:- Tamapravesha, marmachheda, bahi shaitya antardaha, shwasa,kasa,hikka

7. Shukradhatugata:- Shukra moksha,shukra nasha,mrutyu

- Vishama jwara:-

• Vishama jwara is Charecterised by irregular onset, inconsistent sympotoms and appearance in irregular times; and it persist for longer duration.

1. Santata jwara:- Continuous or remittent for 7,10 or 12days. Rasa dhatu is ashraya.

2. Satata jwara:- once in 12hours (twice in 24hrs) dhatu ashraya is Rakta dhatu

3. Anyedhyushka:- Once in 24hrs. Dhatu ashraya is mamsa dhatu

4. Trutiyaka- Every third day(Tertian fever) Dhatu ashraya is meda.

5. Chaturthaka:- Every fourth day(Quartan fever) Dhatu ashraya is asthi majja.

- Jwara avastha:-

1. Taruna jwara:- Jwara upto 7days is called taruna or nava jwara.

2. Aama jwara:- Jwara associated with aama.

3. Pachyamana jwara:- Aama is being digested.

4. Nirama jwara:- Aama has been digested i.e, Jwara free from aama, usually from 8th day jwara is nirama

5. Jirna jwara:- Chronic fever

6. Punaravartaka jwara:- Relapsing fever, jwara which is recurred within few daysm

TREATMENT:-

- Navajwara chikitsa sutra:-

• For the first 7days it is called as navajwara

• General line of treatment of nava jwara is Langhana(fasting) – Swedana(measures to induce sweating) – Kala(passing of time of 8days) – Tikta rasasuddha yavagu pana

• Langhana or upavasa is first line of treatment in jwara. But it is contraindicated in case of vataja,kshayaja,kamaja, krodhaja,bhayaja,shokaja and shrama janya jwara.

- Prohibitions in navajwara:-

• During the initial stage of jwara one should avoid day sleep,bath, massage,heavy food, sexual intercourse,anger, exposure to wind, exercise and decoction and medicine having kashaya rasa

- Shadanga paniya is given to patient to pacify thirst in jwara.

- Vamana in jwara:-

• If vitiated dosha are kapha predominant or situated in amashaya vamana is indicated in jwara.

- Yavagu prayoga:-

• After vamana and Langhana the patient should take manda cooked in decoction of jwarahara dravyas and then he should take yavagu.

• Yavagu sevana should be continued until fever comes down or becomes low grade or it should be continued for 6days.

- Kashaya prayoga:-

• After 6 days of jwara light food like yavagu is given to patient on 7th day and then from 8th day kashaya should be administered which is processed with pachaniya and shamaniya dravya.

• Kasaya is contraindicated in nava jwara.

- Ghritapana:-

• When kapha dosha is less and vata pitta is  more and when dosha are pakwa administration of ghrita is beneficial like amruta.

• If patient having ruksha sharira is not relieving from fever even after vamana, upavasa, laghu ahara and kashaya pana he should be treated with ghruta.

- Dugdhapana:-

• In jwara the patient is suffering from daha and trushna and if vata and pitta are more and in case of baddha mala or nirama dosha administration of dugdha pana is beneficial

- Virechana in jwara:-

• If jwara is not relieved by above methods virechana should be administered to strong patients.

- Basti prayoga:-

• If patient is weak then niruha basti should be administered after dugdha pana.

• In case of strong patients if jwara is jirna, kapha pitta are less, agni is strong and mala is ruksha or Vibandha anuvasana basti should be administered

•Jivantyadi ,patoladi,chandanadi etc. anuvasana basti should be used.

- Nasya prayoga:-

• Shirovirechana should be administered in case of jeena jwara if pateint has shirashoola, shiragaurava and vibaddha Indriyas.

- Bahya upachara:-

• In dahajwara:- Shita abhyanga,pradeha,pariseka and avagaha

• In sheeta jwara:- Ushna abhyanga,pradeha,pariseka and avagaha

• In agantuja jwara:- due to abhichara,abhishapa etc. Dhupana and anjana should be administered.

- Sannipataja jwara chikitsa:-

• Increased the diminished doshas and decrease the aggrivated dosha and treat the kapha dosha sthana first

• Karnamula shotha compilation of sannipataja jwara is treated with Raktamokshana, ghritapana, pradeha,nasya and kavala

- Dhatugata jwara chikitsa:-

• Rasagata:- Vamana and upavasa

• Raktagata:- Raktamokshana,Pralepa and pariseka

• Mamsa and medogata:- Virechana and upavasa

• Asthi and Majjagata:- Niruha and Anuvasana Basti

• Shukragata:- Asadhya

- Vishamajwara chikitsa:-

• Vishamajwara is usually associated with agantuka karana like jivanu,visha,vayu,bhuta,preta etc. it should be treated with yuktivyapashraya chikitsa as well as daivavyapashraya chikitsa.

• In vatapradhana vishamajwara:- Snehapana,Niruha and Anuvasana Basti, snigdha and ushna annapana.

• In pittapradhana vishamajwara:- Virechana, Pittahara dravya siddha ghrita and dugdha, tikta and sheeta dravya

• In kaphapradhana vishamajwara:- Vamana, pacjana dravya, kashaya pana, upavasa, ruksha and ushna dravya

• Daivavyapashraya chikitsa:- Manidharana, pujana, yajna, stuti,bali,mangala, homa, upahara, brahmacharya, tapa, satya,niyama , sadhu darshana etc

- Vishamajwaraghna kashaya:-

• In santata:- Kalingadi kashaya

• In satata:- Patoladi kashaya

• In anyedhyushka:- Nimbadi kashaya

• In trutiyaka:- Kiratatiktadi kashaya

• In chaturthaka:- Guduchyamalakadi kashaya

- Agantuja jwara chikitsa:- Daivavyapashraya chikitsa

- Punaravartaka jwara chikitsa:-

• Mridu shodhana, yapana basti, laghu yusha, jangala mamsarasa, tikta dravyasuddha ghrita, kirattiktadi kwatha, abhyangadi bahya upachara

- Pathya:- Laghu ahara, yavagu, jwaraghna shaka( patola, patha, karavellaka etc.)

Formulations:-

• Vishama jwaranashaka pancha kashaya

• Vatsakadi kashaya

• Madhukadi kashaya

• Jatyadi kashaya

• Triphaladi kwatha

• Bruhatyadi kashaya

• Shatyadi kwatha

• Pippalyadi ghrita

• Chandanadhya taila

• Agurvadi taila