🔘 Plague (Granthika Jwara)

PLAGUE (GRANTHIKA JWARA):

💫 ACCORDING TO MODERN (PLAGUE):-

👉🏻 Introduction:-

- Plague is an infectious disease known as 'black death' caused by 'Yersinia pestis', a gram negative non motile bacillus.

- Enzootic inflammation- rats and other rodents.

- Salvatic rat - through other rat species- Human.

👉🏻 Spread:-

1. Direct contact:-

- Tissue and fluid

- Physical

- Sexual

- Bite

- Droplets

- Laboratory Plague

2. Indirect contact:-

- Soil contaminated surface

- Faecal-oral contaminated food and water

👉🏻 Incubation period:-

- Bubonic Plague:- 2-7 days (can be longer)

- Pneumonic Plague:- less than 1 day upto 4 days following inhalation exposure to yersinia pestis.

👉🏻 Types and Clinical features:-

1) Bubonic Plague:- 

It usually occurs from bite.

Swollen gland is called 'bubo' hence named as bubonic plague.

- High fever with chills

- Vomiting

- Swollen and painful lymph nodes

- Confusion

- Anxiety

- Oligouria

- Most common type of plague

2) Septicaemic Plague:-

- It occurs when bacteria enters in blood stream.

- Septicaemic Plague is complication of untreated bubonic and Pneumonic Plague with

• High fever

• Chills

• Malaise

• Gangrene of acral (extremities of peripheral body parts) regions; top of nose, toes, finger due to small artery thrombosis.

• Abdominal pain

• Shock

3) Pneumonic Plague:-

- Only Plague which can transmitted from person to person.

- Occurs by primary respiratory infection.

- Complication of Septicaemic and bubonic Plague.

- It shows:

• Sneezing

• Headache

• High fever

• Vomiting

• Abdominal pain

• Diarrhoea

• Cough

• Chest pain

• Haemoptysis (blood with cough)

• Respiratory failure quickly with septic shock and mortality is high.

• Difficulty in breathing

• Without antibiotics disease is fatal in 2 to 3 days.

👉🏻 Risk factors:-

- Risk factors for plague include being bitten by fleas as well as exposure to rodents.

- Scratches or bites from infected domestic cats are also a risk factor.

- Contact with individuals with pneumonic plague is also a risk factor for acquiring the infection.

👉🏻 Diagnosis:-

1. Bubonic Plague:-

- Bubo fluid must be taken by using needle from swollen lymph nodes.

2. Pneumonic Plague:-

- Throat swab and sputum is taken from Airways by tube inserting down in nose also called as 'bronchoscopy'.

3. Septicaemic Plague:-

- Blood test (CBC, ESR)

- Thrombocytopenia in 50% cases

- Blood smear

- Leucocyte count > 20,000 mm³

👉🏻 Prognosis:-

- Plague is a very serious disease, often life-threatening disease. 

- About 50% of people with bubonic plague die if their illness is not treated. 

- Pneumonic plague is typically always fatal if untreated. 

- With treatment, about half of people with pneumonic plague will survive.

- The earlier that antibiotic treatment is given, the better the chance for recovery.

👉🏻 Management :-

1) Antibiotics:-

- Fatalitity rate decreases

- 5% in bubonic Plague

- 10% in Septicaemic and Pneumonic Plague.

• Streptomycin is drug of choice

• Gentamicin

• Ciprofloxacin

• Levofloxacin

• Doxycycline for 10 days

2) Isolation:-

- Pneumonic Plague must be isolated from others.

3) Prevention:-

- To prevent human to human transmission (in Pneumonic Plague):- 4 days isolation

- Active surveillance

- Environmental sanitation.

💫 ACCORDING TO AYURVEDA (GRANTHIKA JWARA):

👉🏻 Introduction:-

- The Jwara which produces shotha (swelling) in lasika granthi (lymph nodes) of Greeva (neck), Kaksha and vankshana; and produced due to teevra peeda yukta damsha (bite with excessive pain) is known as 'Granthika Jwara'.

- In modern it is correlated with Plague.

- This disease spreads very quickly and fatal.

- It is entered in human body by bite of rats or other rodents, in which Yersinia pestis bacteria enters and produces this fever.

👉🏻 Nidana:-

• भूम्नारोगातखुभी रोगयुक्तस्थाने श्वासोच्छ्वासतः स्पर्शतोऽपि।

दण्डाकारास्तस्य कीटाणवो वै मूलं प्रोक्तं मूषकोत्था भिषग्भिः॥

- The main reason of Granthika jwara is Yersinia pestis bacteriaz which is present in rats.

👉🏻 Samprapti:-

• यदा मूषकस्थायिकीटः कथंच्चिन्नरं संदशत्यत्र दशात्तदानीम्।

विनिःसृत्य कीटाणवस्तल्लसीकावहासु प्रकुर्वन्ति संचारमेव॥

यदा ते ततो यान्ति तद्ग्रंथिमध्ये तदा क्षोभमायान्ति तद्ग्रंथयोऽपि।

(मा.नि.परि.)

- After bite of rats or other rodents the rogotpadaka jeevanu (bacteria) enters in Lasika and spreads in lasika.

- It reaches to the lasika of greeva, kaksha and vanskhana and produces swelling in lasika.

- It results in enlargement of lasika.

- Teevra jwara is produced due to effect of jivanu janya visha (bacterial toxins).

👉🏻 Samprapti ghataka:-

- Dosha:- Tridosha

- Dushya:- Rasa, Rakta, Lasika

- Srotasa:- Rasavaha, Raktavaha

- Srotodushti:- Sanga

- Adhisthana:- Lasika granthi

- Swabhava:- Ashukari

- Sadhyasadhyatva:- Yapya/Asadhya

👉🏻 Types:-

• तभेदास्तु ग्रंथिक: कीटरक्त: संदृश्यन्ते फुफ्फुसस्य प्रदाही।(मा.नि.परि.)

- According to madhava nidana it is of 3 types:-

1. Granthika (Bubonic)

2. Keeta raktaja (Septicaemic)

3. Phuphphusa pradahi (Pneumonic)

👉🏻 Purvaroopa:-

- Along with samanya lakshana of Jwara, the following purvaroopa will produced in Granthika jwara:-

• व्यथाशीष्णि शैथिल्यमङ्गेषु सादोमनोदैन्यमुत्क्लेशभक्तारुची च।

ज्वरोक्तं च सामान्यं पूर्वरूपं भवेद् ग्रंथिकाख्ये ज्वरोग्दोग्ररुपम्॥ (मा.नि.परि.)

1. Shirashoola (Headache)

2. Shaithilya (Looseness of body)

3. Avasada (Depression)

4. Manasika deenata (Mental fatigue)

5. Jwara (fever)

6. Utklesha (nausea)

7. Aruchi (anorexia)

👉🏻 Lakshana:-

1) Granthika Jwara:-

• तीव्र ज्वरो भवति पूर्वमिहक्वचिद्वामन्दः शिरोरुगरतीवमनं भ्रमश्च।

उत्क्लेशगात्रशिथिलत्वतृषाप्रलापा

उन्मादमोहधमनीद्रुतगामिताश्च॥

इदं ग्रंथिकाख्यज्वरस्याद्यभेद स्वरूपं यथावद् भिषग्भिः प्रदिष्टम्॥

(मा.नि.परि.)

- Teevra jwara (hyperpyrexia)

- Shirashoola (headache)

- Arati (restlessness)

- Bhrama (vertigo)

- Utklesha (nausea)

- Sharira shaithilya (looseness of body)

- Trishna (Polydypsia)

- Pralapa (Delirium)

- Unmada (Psychosis)

- Rapid pulse rate

- Murchha (fainting)

- Nidranasha (sleeplessness)

- Daurbalya (weakness)

- Inflammed lasika granthi

- Tenderness over lymph glands

- Suppuration of lymph glands

- Numbness in ear

2) Keeta Raktaja Granthika jwara:-

• बहुग्रंन्थय: कीटरक्ताख्य भेदे ज्वरे ग्रंन्थिके नापि वर्द्धन्त एव।

भवेत्तत्र रक्तस्य दुष्टिस्तथा च ज्वरस्यानिशं तीव्रता वै विशेषात्॥ 

(मा.नि.परि.)

- Teevra jwara (Hyperpyrexia)

- Pulse weak and fast

- Sangya nasha (loss of sensation)

- Sannipataja jwara Lakshana

3) Phuphphusa pradahi Granthika jwara:-

• शीतपूर्वक दारुण ज्वर आशु संजायतेहि, शिरसि शूलमथाङ्गमर्दो भ्रमश्चोत्क्लेशोऽधिमाहि........ लक्ष्य जातं लक्ष्यते ॥

(मा.नि.परि.)

- No enlargement of lasika granthi

- Sheeta purvaka jwara (fever with chills)

- Shirashoola (headache)

- Angamarda (bodyache)

- Bhrama (vertigo)

- Utklesha (nausea)

- Urashoola (chest pain)

- Kasa (cough)

- Kantha kunjana (wheezing)

- Rakta sthivana (Haemoptysis)

- Consolidation of lungs

👉🏻 Upadrava:-

• कासोऽतिसारोऽप्यथ रक्तपित्तं मूत्रावरोधो वमनं तथैव।

उपद्रवा ग्रंथिक नामकेऽस्मिन् ज्वरे त्वमी बैद्यजनैः प्रदिष्टाः ॥(मा.नि.परि.)

1. Kasa (cough)

2. Atisara (Diarrhoea)

3. Raktapitta (Epistaxis)

4. Mutavarodha (Retension of urine)

5. Vamana (Vomiting)

👉🏻 Sadhyasadhyatva:-

• सर्वोन्द्रियाणां मनसोऽप्यशेषव्यापारनाशो यदि वाऽतिसारः।

अत्युल्बणा स्यात्तुतदा सुवैद्याऽरिष्ट वद्द ग्रंथिकपीडितस्य॥

ष्ठीवेत् सुसिन्दूर समोज्वलं चेद् रक्तं कफेनानुगतं तु रोगी॥(मा.नि.परि.)

It is considered as sukha sadhya if :

- Granthis are at many places

- Shighra paki

- Patient is of Children or old age

It is considered as Asadhya if :

- Atisara at peak

- Kapha sthivana of Sindura varna

- Teevra shwasa

- Loss of sensory functions

👉🏻 Chikitsa Siddhanta:-

- Nidana parivarjana

- Uttama paricharya and drava ahara

- Ushna seka on granthis, and if Suppuration present then Incision is made on it.

- Lakshanika chikitsa (symptomatic treatment) of patient should be done.

- Prevention from rats and rodents should be done

👉🏻 Chikitsa:-

- All jwarokta Samshamana yoga

1) Rasa / Bhasma / Pishti:-

Matra:- 125-250 mg

Anupama:- Ushnodaka / Madhu

- Tribhuvanakirti rasa

- Hunguleshwara rasa

- Swarna vasanta malati rasa

- Kasturi bhairava rasa

- Jwara keasari rasa

- Jwara Samhara rasa

- Godanti and shringa bhasma

- Jaharamohara pishti

- kaphaketu rasa

2) Vati:-

Matra:- 250-500mg (1-2 tab)

Anupana:- Ushnodaka

- Sanjivani vati

- Saubhagya vati

- Samshamani vati

- Vishatindukadi vati

- Jaya vati

- Amruta sattwa

3) Churna:-

Matra:- 3-6 gm

Anupana:- Ushnodaka

- Sudarshana churna

- Panchakola churna

- Sitopaladi churna

- Talisadi churna

- Lavangadi churna

4) Kwatha / Asava / Arishta:- 

Matra:- 10-20 ml

Anupana:- Jala

- Nagaramotha + Parpata

- Sunthi + Parpata

- Patha + Khasa + sugandhabala

- Patola panchaka kwatha

- Darvyadi kwatha

- Guduchyadi kwatha

- Amritarishta

5) Ghrita / Taila:-

Matra:- 10-20 ml

Anupana:- Ushnodaka

- Panchatikta ghrita

- Amrutadi ghrita

- Shatapalaka ghrita

- Chandanadi ghrita 

6) Avaleha:-

Matra:- 20-30 gm

Anupana:- Dugdha

- Drakshavaleha

- Chyavanprasha

- Specific yogas are:-

1. Bruhat vatachintamani rasa

2. Yogendra rasa

3. Bruhat Kasturibhairav rasa

4. Chandeshwara rasa

5. Tamrea bhasma

6. Rasa sindoor

7. Ashwagandha churna

8. Shatavari choorna

9. Rohitaka lauha

👉🏻 Pathyapathya:-

1) Pathya:-

Ahara:-

- Purana shali, mudga, masura, karavellaka, sahijana, chaulai, guduchi, jeevanti, munakka, kapittha, dadima.

- Laghu ahara

- Yavagu, peya, vilepi, yava, laja manda etc.

Vihara:-

- Langhana

- Vamana

- Virechana

- Basti

- Nasya

- Abhyanga

- Vishrama

2) Apathya:-

Ahara:-

- Guru, vidahi, vishtambhi padartha

- Dushita jala sevana

- Ankurita anna, tilakuta, samosa, kachori, pizza, burger, Halwa, mithai, lassi etc.

Vihara:-

- Vegadharana

- Vyayama

- Diwaswapna

- Snana

- Maithuna

- Adhyashana