अथातो ज्वरनिदानं व्याख्यास्यामाः । इति ह स्माहुरात्रेयादयो महर्षयः ॥१॥
Now, we will expound Jvara nidanam – diagnosis of Fevers; thus said Atreya and other great sages. (1)
Jvara bheda – Types of fevers
अष्टाभिः कारणैर्ज्वरः सञ्जायते मनुष्याणां पृथग्दोषैः संसृष्टैः सन्निपतितैरागन्तुना च ॥ २ ॥
Jvara (fever) develops in human beings by eight causes – viz, from each of the doshas seperately, from their samsarga (combination of any two), from sannipata (combination of all three) and from agantu (external causes). (2)
Notes : Fever is classified as follows three from each dosha seperately (ekadoshaja. viz, vataja, pittaja and kaphaja), three from combination of any two doshas known as dvandvaja, dvidoshaja, sansargajasansrsta, viz, vatapittaja, vatakaphaja, kaphapittaja); one from the combination of all the three doshas-known as tridoshaja, sannipataja sarvaja); and one from agantu ( external agents).
Jvara Samprapti- pathogenesis of fever
तत्र यथोक्तैः प्रकोपणविशेषैः प्रकुपिता दोषाः प्रविश्यामाशयमूष्मणा मिश्रीभूयाममनुगम्य रसस्वेदवाहीनि स्त्रोतांसि पिधाय पित्तं तु द्रवत्वात्तप्तमिव जलमनलमुपहत्य सर्वेऽपि च दोषाः पक्तारंस्वस्थानाद्बहिर्निरस्य सहतेन सकलमपिशरीरमभिसर्पन्तः तत्सम्पर्काल्लब्धबलेन स्वेनोष्मणा नितरां देहोष्माणमेधयन्तोऽन्तस्त्रोतोमुखपिधानात् स्तम्भमादधाना बहिरपि स्वेदमपहरन्तः सर्वेन्द्रियाणि चोपतापयन्तो ज्वरमभिनिर्वर्तयेत् ॥ ३ ॥
The doshas undergoing increase from the causes mentioned earlier enter the amasaya (receptacle of undigested food – the stomach), getting mixed with the heat present there and associating with ama (indigested or improperly digested food material), close the channels of rasa (the circulating first dhatu) and sveda ( sweat ). Just like hot water (extinguishes the fire), pitta by its (increased) liquidity, diminishes the (internal) fire; all the doshas (each of them) dislodge the digestive fire from its natural seat to the exterior, begin to move along with it all over the body, getting strengthened by its association, they (doshas) cause increase of the heat of the body, inactivate the internal channels by closing their mouth (orifices), not allow sveda (sweat) to come out and causing distress in all the sense organs, produce Jvara (fever). (3)
Jvara Purva rupa – prodromal symptoms of fever
तस्येमानि पूर्वरूपाणि मुखवैरस्यमन्नानभिलाषो गुरुगात्रत्वमालस्यमल्पप्राणता गतिस्खलनं निद्राधिक्यमरतिरसूया हितोपदेशेषु प्रद्वेषो बालेषु मधुरेषु च भक्ष्येष्वम्ललवणकटुकाभिनन्दनमविपाकेऽङ्गमर्दश्चक्षुषोराकुलत्वं साश्रुता जृम्भा विनाम: क्लमो रोमहर्षः शब्दानलाम्बुशीतवातच्छायातपेष्वकस्मादिच्छाद्वेषौ च । तदनन्तरं व्यक्तीभावो ज्वरस्येति । भवति चात्र ॥४॥
The following are its purvarupa – ( Prodromal symptoms ). Bad taste in mouth, lack of desire for food, feeling of heaviness of the body, lazyness, lack of strength, unsteady gait, excess of sleep, restlessness, lack of faith in good advises, hatredness towards children and sweets; desire for sour, salt and pungent things; indigestion, body-ache, accumulation of dirt and tears in the eyes, (too much of) yawning, bending of the body (voluntarily), debility (without any effort), horripilations; like and dislike – without any apparant reason – for sound, fire, water, cold breeze, shade and sunlight; then follows the manifestation of Jvara (fever). Further on Rupa – clinical features. ( 4 )
Vataja jvara lakshana – features of fever caused by vata
आगमापगमक्षोभमृदुता वेदनोष्मणाम् । वैषम्यं तत्र तत्राङ्गे तास्ताः स्युर्वेदनाश्चलाः ॥५॥
पादयोः सुप्तता स्तम्भः पिण्डिकोद्वेष्टनं क्लमः । विशेष इव सन्धीनां साद ऊर्वोः कटीग्रहः ॥ ६ ॥
पृष्ठं क्षोदमिवाप्नोति निष्पीड्यत इवोदरम् । भिद्यन्त इव चास्थीनि पार्श्वगानि विशेषतः ॥७॥
हृदयस्य ग्रहस्तोदः प्राजनेनेव वक्षसः । स्कन्धयोर्मथनं बाह्वोर्भेदः पीडनमंसयोः ॥८॥
अशक्तिर्भक्षणे हन्वोजृम्भणं कर्णयोः स्वनः । निस्तोदःशङ्खयोर्मूर्ध्नि वेदना विरसास्यता ॥९॥
कषायास्यत्वमथवा मलानामप्रवर्तनम् । रूक्षारुणत्वगास्याक्षिनखमूत्रपुरीषता ॥१०॥
प्रसेकारोचका श्रद्धाविपाकास्वेदजागराः । कण्ठौष्ठशोषस्तृद्शुष्कौ छर्दिकासौ विषादिता ॥ ११ ॥
हर्षो रोमाङ्गदन्तेषु वेपथुः क्षवथोर्ग्रहः । भ्रमः प्रलापो घर्मेच्छा विनामश्चानिलज्वरे ॥१२॥
Irregularity of onset and relief, mild symptoms and temparature; symptoms of increase of vata in different parts, loss (decrease) of sensation and stiffness of the feet, twisting pain in the calves, exhoustions without any effort, looseness of the joints, weakness in the thighs, catching pain in the waist, twisting pain the back, chrning pain in the abdomen, cutting pain in the bones, especially of the flanks, catching or pricking pain in the (region of) the heart, peircing pain in the chest, churning pain the shoulders, cutting pain in the arms, squeezing pain in the shoulder joint, inability to masticate by the lowerjaw, increase of yawning, ringing in the ears, pain in the temples, headache, bad taste or astringent taste in the mouth, non-elimination of the waste (faeces, urine etc) dryness and slightly reddish colour of the skin, mouth, eyes, nails urine and faeces; salivation, loss of appetite, lack of desire (for foor) indigestion, absence of perspiration, loss of sleep, dryness of the throat, and lips, thirst, vomiting and cough without fluid material, grief (sorrow), horripilations, chills in the body and teeth, rigors, abscence of sneezing, giddiness, irrelevent talk, desire for warmth (sunlight or heat) and bending the body voluntarily-these are the symptoms of Anilaja jvara (fever caused by increased vata). (5-12)
Pittaja jvara – fever caused by pitta
युगपद्व्याप्तिरङ्गानां प्रलापः कटुवक्त्रता। नासास्यपाकः शीतेच्छा भ्रमो मूर्छा मदोऽरतिः ॥१३॥ विट्स्रंसः पित्तवमनं रक्तष्ठीवनमम्लकः । रक्तकोठोद्गमः पीतहरितत्वं त्वगादिषु ॥१४॥ स्वेदो निश्वासवैगन्ध्यमतितृष्णा च पित्तजे ॥१५॥
Heat (temperature) manifesting in all the parts of the body simulatenously, delerum, bitter taste in the mouth, ulceration of the nose and mouth; desire for cold comfort, vomiting of bile, haemoptysis sour-belching, appearance of red, raised patches, yellow or greenish colour of the skin etc, perspiration, bad smell in the expired air and severe thirst – are the symptoms of Pittaja jvara (fever caused by increased pitta). (13-15)
Kaphaja jvara – fever caused by kapha
विशेषादरुचिर्जाड्यं स्त्रोतोरोधोऽल्पवेगता । प्रसेको मुखमाधुर्यं हल्लेपश्वासपीनसाः ॥१६॥
हल्लासर्दनं कासः स्तम्भः श्वैत्यं त्वगादिषु ॥१७॥
अङ्गेषु शीतपिटकास्तन्द्रोदर्दः कफोद्भवे ॥ १८ ॥
Loss of taste specially, lassitude, obstruction of the pores and passages, mild manifestation (of temperature and other symptoms) (increased) salivation, sweet taste in the mouth, moistness in the region of the heart, dyspnoea or increased (respiration), running in the nose, oppression in (the region of) the heart (nausea), vomiting cough, stiffness (of the body), coldness of the skin etc, appearance of cold eruptions in different parts, stupor, and eruptions in the skin these are the symptoms of Kaphaja jvara (fever caused by increased kapha). (16-18)
काले यथास्वं सर्वेषां प्रवृत्तिर्वृद्धिरेव वा । निदानोक्तानुपशयो विपरीतोपशायिता ॥ १९ ॥
Onset and exacerbation of these fevers occur at the usual time of the increase (of causative doshas); indulgence in factors which are mentioned as causes will act as anupasaya (cause more discomfort and so unsuitable) while indulgence in factors which are opposite (of those mentioned as causes) act as upasaya (bring comfort and so suitable). (19)
Samsargaja jvara – fever caused by two doshas together
यथास्वं लिङ्गसंसर्गे ज्वरः संसर्गजोऽपि च ॥२०॥
If there is a mixture of symptoms (of any two doshas) then that fever is to be understood as Samsargaja (caused by increase of any two doshas simultaneously). (20) शिरोऽर्तिमूर्छावमिदाहमोहकण्ठास्यशोषारतिपर्वभेदाः ।
उन्निद्रतातृड्भ्रमरोमहर्षा जृम्भातिवाक्त्वं च चलात् सपित्तात् ॥२१॥
Headache, fainting, vomiting, burning sensation, delusion, dryness of the throat and mouth, restlessness, pain in the joints, loss of sleep, thirst, giddiness, horripilations (increased yawning, and excess of talking – are found in fever due to Vatapitta (increased together). (21)
तापहान्यरुचिपर्वशिरोरुक्पीनसश्वसनकासविबन्धाः।
शीतजाड्यतिमिरभ्रमतन्द्राः लेष्मवातजनितज्वरलिङ्गम् ॥ २२ ॥
Mild temperature, loss of taste, pain in the joints, and head running in the nose, increased (difficult) breathing, cough, constipation chills, lassitude (inactivity), feeling of darkness (or loss of consciousnes) giddiness, stupor, are the symptoms of Kaphavata jvara (fever caused by increased kapha and vata together). (22)
शीतस्तम्भस्वेददाहाव्यवस्था तृष्णा कासः श्रेष्मपित्तप्रवृत्तिः । मोहस्तन्द्रा लिप्ततिक्तास्यता च ज्ञेयं रूपं श्रेष्मपित्तज्वरस्य ॥२३॥
Chills, stiffness of the body, perspiration, burning sensation all being erratic (irregular), thirst, cough, elemination of kapha, and pitta, delusion, stupor, mouth coated and having bitter taste – these are the features of Kaphapitta jvara (increase of kapha and pitta together). (23)
Sannipataja jvara – fever caused by three doshas together
सर्वजो लक्षणैः सर्वैर्दाहोऽत्र च मुहुर्मुहुः । तद्वच्छीतं महानिद्रा दिवा जागरणं निशि ॥२४॥
सदा वा नैव वा निद्रा मुहुः स्वेदोऽति नैव वा । गीतनर्तनहास्यादिविकृतेहाप्रवर्तनम् ॥ २५ ॥
सस्त्रुती कलुषे रक्ते भुग्ने लुलितपक्ष्मणी । अक्षिणी पिण्डिकापार्श्वमूर्धपर्वास्थिरुग्भ्रमः ॥२६॥
सस्वनौ सरुजौ कर्णौ कण्ठः शूकैरिवावृतः । परिदग्धा खरा जिह्वा गुरुस्त्रस्ताङ्गसन्धिता ॥२७॥
रक्तपित्तकफष्ठीवो लोलनं शिरसोऽतितृट् । कोठानां श्यावरक्तानां मण्डलानां चदर्शनम् ॥ २८ ॥
हृद्व्यथा मलसंसङ्गः प्रवृत्तिर्वाल्पशोऽति वा । स्निग्धास्यता बलभ्रंशः स्वरसादः प्रलापिता ॥२९॥
दोषपाकश्चिरात्तन्द्रा प्रततं कण्ठकूजनम् । सन्निपातमभिन्यासं तं ब्रूयाच्च हृतौजसम् ॥३०॥
In fevers caused by all the doshas, the symptoms of all the three doshas will be present; such as feeling of burning sensation or cold sensation often, too much of sleep, during day and its absence at nights, or too much of sleep, during day and its absence at nights or too much of sleep, during day and its absence at nights or too much of sleep always or not at all, either to much of sweating or no sweating at all, lack of interest in music, dance, humor (laughter), eyes full of tears and excreations (dirt), reddish, and in drawn with matted eye – lashes, pain in the calves, flanks, head, joints and bones, giddiness, ringing and pain the ears, feelings as though the throat is full of throns, the tongue as though burnt at its borders and rough, body parts and joints feeling heavy and falling down (due to debility) expectoration of blood, bile and phlem, rolling of the head (on the pillow), severe thirst, appearance of blackish-red patches on the skin, pain in the region of heart, accumulation of wastes or their elimination either very less or very copious, (excess of) slivation, loss of strength, weakness of voice, delereium (irrelevent talk), delay in the paka (maturation by heat), of the doshas, stupor and continous moaning sound from the throat this condition (fever) is known as Sannipata jvara and also as Abhinyasa jvara or Hrtaujasa vara (fever caused by the increase of all the three doshas together.) (24-30)
वायुना कफरुद्धेन पित्तमन्तः प्रपीडितम् । व्यवायित्वाच्च सौक्ष्म्याच्च बहिर्म प्रवर्तते ॥ ३१ ॥
तेन हारिद्रनेत्रत्वं सन्निपातोद्भवे ज्वरे । दोषे विबद्धे नष्टेऽग्रौ सर्वसम्पूर्णलक्षणः ॥३२॥
असाध्यः सोऽन्यथा कुच्छ्रो भवेद्वैकल्यदोऽपि वा ॥३३॥
Pitta being hindered (not allowed to move) inside the body by vata and kapha obstructing its passages, comes out to the exterior (to the skin and other dhatus) due to its vyavayi (quick spreading) and suksma (thin, capacity to enter into minute pore) properties and produces yellow colour in the eyes in sannipata jvara.
Sannipata jvara, in which the doshas are obstructed (in their movement and function), the agni (digestive activity) has been lost (decreased greatly or totally absent) and in which all the symptoms are present, becomes either incurable or curable with difficulty or produces some deformity of the body. (31-33)
अन्यच्च सन्निपातोत्थो यत्र पित्तं पृथक्स्थितम् । त्वचिकोष्ठेऽथवा दाहं विदधाति पुरोऽनु वा ॥३४॥
तद्वद्वातकफौ शीतं दाहादिर्दुस्तरस्तयोः ॥३५॥
In another variety of sannipata jvara, where pitta remains seperately, either in the skin or the alimentary tract, produces burninig sensation either at the onset or later; similarly vata and kapha produce cold feeling (chills), both these fevers preceeded by either burning sensation or by cold (chills, rigors) will make the fever difficult to cure. (34-35)
शीतादौ तत्र पित्तेन कफे स्यन्दितशोषिते । शीते शान्तेऽम्लको मूर्च्छा मदस्तृष्णा चजायते ॥३६॥
दाहादौ पुनरन्ते स्युस्तन्द्राष्ठीववमिक्लमाः ॥३७॥
If the kapha is liquified and made dry (devoid of unctousness) there is cold (chills) at the commencement, after the cold subsides, sourness (belching), fainting, toxicity, and thirst develops, if there is burning sensation at the commencement, stupor, expectoration, vonmitting and exhaustion develop at the end. (36-37)
Agantu jvara – fever caused by external causes
आगन्तुरभिघाताभिषङ्गशापाभिचारतः । चतुर्धात्र क्षतच्छेददाहाद्यैरभिघातजः ॥३८॥
श्रमाच्च तस्मिन् पवनः प्रायो रक्तं प्रदूषयन् । सव्यथाशोफवैवर्ण्य सरुजं कुरुते ज्वरम् ॥ ३९ ॥
Agantu jvaras (fevers due to external causes) are four viz, due to Abhighata (injury/ trauma), Abhisanga (possession by evil spirit, worms, bacteria etc), Abhisapa (curse) and Abhicara (witch-craft).
Abhighata is injury like cuts, tear (puncture), burning by fire, and exertion etc; in this, vata vitiates rakta (blood), and produces jvara accompanied with pain, swelling, discolouration and pain. (38-39)
ग्रहावेशौषधिविषक्रोधभीशोककामजः । अभिषङ्गाद् ग्रहेणास्मिन्नकस्माद्धासरोदने ॥ ४० ॥
ओषधीगन्धजे मूर्छा शिरोरुक् श्वयथुः क्षवः । विषान्मूर्छातिसारास्यश्यावतादाहहृद्गदाः ॥४१॥
क्रोधात् कम्प: शिरोरुक्चप्रलापो भयशोकजे । कामान्मोहोऽरुचिर्दाहोद्गानिद्राधिघृतिक्षयः ॥४२॥
Abhisanga is possession by evil – spirits (and micro-organisms) inhalation of smell (contact with pollen of grass, flowers, smell of medicinal plants etc ), poisons, emotions like anger, fear, sorrow and lust. In fever caused by the smell of pollen etc, there is fainting, headache, swelling, and sneezing, in fever due to poison, there appears fainting, diarrhoea, black colouration of the mouth, burning sensation and pain in the (region of the) heart, in that due to anger there appears tremors and headache, in that due to fear and grief, delerium, is seen in fever dur to lust, there will be delusion loss of appetite, burning sensation, lack of shvness, sleep, intellegence, and courage. (42)
ग्रहादौ सन्निपातस्य भयादौ मरुतस्त्रये । कोपः क्रोधे तु पित्तस्य
– यौ तु शापाभिचारजौ । सन्निपातज्वरौ घोरौ तावसह्यतमौ मतौ ॥४३॥
In fevers due to the first three (possession by evil spirits, smell of pollen and poison), and in fevers due to next three (fear, grief and lust), there is increase of vata, in that due to anger, there is increase of pitta; those caused by curses and witch craft will have increase of the three doshas and impossible to bear ( or cure ). 43 )
तत्राभिचारिकैर्मन्त्रैर्हृयमानस्य तप्यते । पूर्वं चेतस्ततो देहस्ततो विस्फोटतृड्भ्रमैः ॥४४॥
सदाहमूर्थैर्ग्रस्तस्य प्रत्यहं वर्धते ज्वरः । इति ज्वरोऽष्टधा दृष्टः –
In fever due to witchcraft by the hymns being uttered, the mind becomes troubled first, next the body gets affected. Next follows the appearance of vesicles (eruptionsthirst, giddiness, burning sensation, fainting and increase of temperature day after day, Thus are seen the eight kinds of fevers. (44-45a)
Jvara vibhaga – kinds of fever
समासाद्विविधस्तु सः ॥ ४५ ॥
शारीरोमानसः सौम्यस्तीक्ष्णौऽन्तर्बहिराश्रयः। प्राकृतौवैकृतःसाध्योऽसाध्यःसामोनिरामकः ॥४६॥
In brief, it (fever) is of two kinds. viz, sharira (somatic), manasa (psychic); saumya (mild) and tiksna (severe); antarasraya (localised inside the alimentary tract/internal) and bhirasraya (localised externally in the skin and other tissues); prakrta (seasonal, natural) and vaikrta (unseaonal, unnatural) sadhya (curable) and asadhya (incurable); sama (associated with ama, the unripe or early stage) and nirama (devoid of ama, the ripe or late stage). (45b-46)
पूर्वं शरीरे शारीरे तापो मनसि मानसे | पवने योगवाहित्वाच्छीतं श्रेष्मयुते भवेत् ॥४७॥ । दाहः पित्तयुते मिश्रं मिश्रे
In sharira jvaras (somatic fevers) distress due to increased heat is found first in the body, while in Manasa (psychic ) it is first found in the mind; Vata being yogavahi (ambivalent) produces cold when associated with kapha (as in saumyajvara) and burning sensation when associated with pitta (as in tiksna jvara) and when associated with both (kapha and pitta) it produces all the symptoms. (47-48a)
अन्तः संश्रये पुनः । ज्वरेधिकं विकाराः स्युरन्तः क्षोभो मलग्रहः ॥४८॥
बहिरेव बहिवेंगे तापोऽपि च सुसाध्यताः ॥४९॥
In Antarasraya (internal fever) profound abnormalities are seen more inside with high temperature, discomfort and non-elimination of wastes (feaces, urine etc) and in Bahirasraya, abnormalities are seen more in the exterior (skin), including the temperature – this type is easily curable. (48b-49)
वर्षाशरद्वसन्तेषु वाताद्यैः प्राकृतः क्रमात् । वैकृतोऽन्यः सदुःसाध्यः प्रायश्चप्राकृतोऽनिलात् ॥५०॥
एकमार्गक्रियारम्भव्यतिवृत्तेर्महात्ययात् ॥५१॥
Fevers arising in varsa (rainy), sarat (autumn) and vasanta (sping) seasons caused by (increase of) vata, pitta and kapha respectively are Prakrta ( natural to the season) whereas others (caused by other doshas in these seasons) are Vaikrta (unnatural to the season) which are difficult to cure. Even among prakrta jvaras, that due to vata is generally difficult to cure because of unsuitability of any one kind of treatment and the risk of great abnormalities. (50-51)
वर्षासु मारुतो दुष्टः पित्तश्लेष्मान्वितो ज्वरम् । कुर्यात् पित्तं च शरदि तस्य चानुबलः कफः॥५२॥
तत्प्रकृत्या विसर्गाच्च तत्र नानशनाद्भयम् । कफो वसन्ते तमपि वातपित्तं भवेदनु ॥ ५३॥
Vata undergoing aggravation (increase) during varsa (rainy season) produces fever associating with pitta and kapha later on, pitta undergoing increase in sarat (autumn) produces fever, associating with kapha later, it is by the (effect of) prakriti (in the former) and by visarga (in the latter); so there is no fear, even if the patient does not take any food; kapha undergoing increase during vasanta (spring) produces fever associating with vata and pitta later on. (52-53)
Notes: Indu the commentator, explains the above statement as follows. The cause for vata producing fever in varsa rtu is the strength of the season, natural to it (prakriti ), the cause for pitta producing fever in sarad rtu is also the strength of season, the rtu belonging to visargakala (during the all the living beings will be having good natural strength). In vata jvara developing in varsa rtu there is no harm even if the patient fasts, because vata is asociated with the pitta and kapha; similarly in pitta jvara developing in saradrtu also there is no harm by fasting because pitta is associated with kapha; the cause for kapha jvara developing in vasanta rtu is prakrta (natural strength of the season) and also that vasanta rtu belongs to adanakala (during which all living beings will having weak natural strength), so in kapha jvara occuring in vasanta, the patient should be protected from fasting too much (he should not be allowed to become weak).
बलवत्स्वल्पदोषेषु ज्वरः साध्योऽनुपद्रवः । सर्वथा विकृतिज्ञाने प्रागसाध्य उदाहृतः ॥५४॥
Fever occuring in strong persons, produced by mild (increase of) doshas and not having complications (secondary or concurrent diseases) is curable; those which are incurable have been described earlier in Vikrtijnana (chapter 2 of Sharirasthana). (54)
ज्वरोपद्रवतीक्ष्णत्वमग्लानिर्बहुमूत्रता । न प्रवृर्त्तिर्न विड्जीर्णा न क्षुत्सामज्वराकृतिः ॥५५॥
ज्वरवेगोऽधिकं तृष्णा प्रलापः श्वसनं भ्रमः । मलप्रवृत्तिरुत्क्लेशः पच्यमानस्य लक्षणम् ॥५६॥
जीर्णतामविपर्यासात् सप्तरात्रं च लङ्गनात् ॥५७॥
Severity of all the symptoms, abscence of debility, copious urination, nonelimination of faeces and faeces not well cooked (processed by heat) and abscence of hunger-are the symptoms of Amajvara (early stage of fever when it is still unripe).
Increase of temperature to a high degree, thirst, delerium, increased/difficult breathing, giddiness, elimination of faeces and nausea – are the symptoms of Pacyamana jvara (fever in the process of undergoing ripening, the middle stage of fever).
Pakva jvara (matured, ripe fever) is known by the ( appearance of) symptoms opposite of ama, after lapse of seven days or after (good) fasting. (55-57)
Visama jvara irregular fevers/ intermittant fevers
ज्वरः पञ्चविधः प्रोक्तो मलकालबलाबलात् । प्रायः स सन्निपातेन भूयसा त्वपदिश्यते ॥५८ ॥ सन्ततः सततोऽन्येद्युस्तृतीयकचतुर्थकौ ॥ ५९॥
Fever is of five kinds depending upon the strength or weakness is the time of increase of the malas (doshas). Generally they are sannipataja (produced by increase of all the three doshas together) and are differentiated by the predominant (dosha); they are Santata, Satata, Anyedyu, Trtiyaka and Chaturthaka. (58-59)
धातुमूत्रशकृद्वाहिस्रोतसां व्यापिनो मलाः । तापयन्तस्तनुं सर्वां तुल्यदूष्यादिवर्धिताः ॥६०॥
The malas (doshas) which have occupied the srotas ( channels, pores) of dhatus (tissues), mutra (urine) and Sakrt (faeces) getting further increased by association with dusyas (dhatus and malas) of identical qualities produce fever causing increase of temperature in the entire body. (60)
बलिनो गुरवः स्तब्धा विशेषेण रसाश्रिताः । सन्ततं निष्प्रतिद्वन्दा ज्वरं कुर्युः सुदुस्सहम् ॥६१ ॥
Those (doshas) which are strong (greatly increased), heavy ( because of presence of ama), static (moving neither upwards or downwards), residing especially in rasa dhatu and having no antagonists (restraining factors) produce Santata jvara which is difficult to cure. (61)
मलाञ्चरोष्मा धातून वा सशीघ्रं क्षपयंस्ततः । सर्वाकारं रसादीनां शुध्याऽशुध्यापि वा क्रमात् ॥६२॥
The heat of this fever ( santata) causes depletion of either malas (doshas) or dhatus (tissues) quickly, and next produces symptoms of all kinds (characteristic of all the three doshas) either in pure (unmixed) or impure ( mixed up ) from respectively. (62)
Notes: When only the doshas are affected by the heat of the fever, the symptoms developing are said to be pure (unmixed, pertaining only to the doshas) and when the dhatus are also affected then the symptoms are inpure (mixed, pertaining both to doshas and dhatus).
वातपित्तकफेः सप्त दश द्वादशवासरान् । प्रायोऽनुयाति मर्यादां मोक्षाय च वधाय च ॥६३ ॥
इत्यग्निवेशस्य मतं – हारीतस्य पुनः स्मृतिः ॥६४ ॥
Santata jvara having the predominance of vata, pitta and kapha generally continue for seven, ten and twelve days respectively, this is the schedule of time for leaving or killing (the patient ), thus opines Agnivesa. (63)
द्विगुणा सप्तमी यावन्नवम्येकादशी तथा । एषा त्रिदोषमर्यादा मोक्षाय च वधाय च ॥६५॥ शुध्यशुद्धौ ज्वरः कालं दीर्घमप्यनुवर्तते ॥६६॥
Harita (states differently ) double of seven (14), nine (18) and eleven (22) is the stipulated schedule (of time) for the three doshas (respectively) for leaving or killing (the patient).
The fever thus persists for long periods, whether (the rasa and other dhatus are) pure (not vitiated) or impure (vitiated). (64-66)
कृशानां व्याधिमुक्तानां मिथ्याहारादिसेविनाम् । अल्पोऽपि दोषो दूष्यादेर्लब्ध्वान्यतमतो बलम् ॥६७॥
सप्रत्यनीको विषमं कुर्याद्वृद्धिक्षयान्वितः ॥६८॥
In persons, who are emaciated who are just relieved of any diseases, who indulge in unsuitable foods and activities, even little quantities of doshas obtaining strength by associating with any of the dusysa (dhatus and malas) undergoing increase or decrease and having hinderances (factors which interfere with their work) produce Visama jvaras (irreregular fevers). (67-68)
सूक्ष्मसूक्ष्मतरास्येषु दूरदूरतरेषु च । दोषो रक्तादिमार्गेषु शनैरल्पश्चिरेण यत् ॥६९॥
याति देहं च नाशेषं भूयिष्ठं भेषजेऽपि च । क्रमोऽयं तेन विच्छिन्नसन्तापो लक्ष्यते ज्वरः ॥ ७० ॥
विषमो विषमारम्भक्रियाकालोऽनुषङ्गवान् ॥७१ ॥
In the channels of rakta etc, which have small and smaller orifices, located farther and very farther, the doshas travel slowly, in little quantity and after long time, do not spread to all the parts of the body simultaneously but only to the predominant (parts), so also is the movement of the medicine ( administered during the course of this fever). This is the manner ( of action); hence this fever is seen with interrupted distress (in other words with intervals of reliefs ) it is called Visama (irregular) because of its iregular onset, action, time and recurance (reppearance). (69-71)
यथोत्तरं मन्दगतिर्मन्दशक्तिर्यथा यथा । कालेनाप्नोति सदृशान् स रसादींस्तथा तथा ॥७२॥
दोषो ज्वरयति क्रुद्धश्चिराच्चिरतरेण च ॥७३॥
As the doshas undergo slow movement and weakness of activity in further periods of time as and when they reach rasa and others (dhatus) situated far and farther of similar nature, then they (doshas) becoming increased, produce fevers after long or longer periods of time. (72-73)
भूमौ स्थितं जलैः सिक्तं कालमेव प्रतीक्षते । अङ्कुराय यथा बीजं दोषबीजं रुजे तथा ॥७४॥
Just as a seed sown in the soil and fed with water, still awaits a certain time to sprout, so also the seed of the doshas to produce fever (74)
वेगं कृत्वा विषं यद्वदाशये लीयतेऽबलम् । कुप्यत्याप्तबलं भूयः काले दोषविषं तथा ॥७५ ॥
एवं ज्वराः प्रवर्तन्ते विषमाः सततादयः ॥७६॥
दोषः प्रवर्तते तेषां स्वे काले ज्वरयन् बली । निवर्तते पुनश्चैष प्रत्यनीकबलाबलः ॥७७॥
क्षीणे दोषे ज्वरः सूक्ष्मो रसादिष्वेव लीयते । लीनत्वात् कार्यवैवर्ण्यजाड्यादीनादधाति सः ॥७८ ॥
When the doshas become weak, the fever is very mild and gets concealed in rasa and other (dhatus); thus dissolved (concealed in) they give rise to emaciation, discolouration, inactivity etc. (78)
अतिलीनोऽतिमन्दत्वात् भवत्यहि न पञ्चमे ॥७९॥
Fever does not manifest on the fifth day, as it would have become greatly dissolved and so is very slow in action. (79)
दोषो रक्ताश्रयः प्रायः करोति सततं ज्वरम् ॥८० ॥
अहोरात्रस्य स द्विः स्यात्सकृदन्येद्युराश्रितः॥८१॥
तस्मिन्मांसवहा नाडीर्मेदोनाडीस्तृतीयके । ग्राही पित्तानिलान्मूर्ध्नस्त्रिकस्य कफ पित्ततः ॥८२ ॥
स पृष्ठस्यानिलकफात् स चैकाहान्तरः स्मृतः ॥८३ ॥
Generally, the doshas residing in the channels of rakta (blood) produce Satata jvara which manifests twice a day; those residing in the channels of mamsa produces Anyedyu (jvara) manifesting once a day; those residing in the channels of medas (fat) produces Trtiyaka (jvara), which manifests by catching (pain) the head if pitta and vata are predominant, by catching in the triangle of shoulder, axilla and back if kapha and pitta are predominant, and by catching the back, if vata and kapha are predominant. It appears with an interval of one day in the middle. (80-83)
चतुर्थको मले मेदोमज्जास्थ्यन्यतमस्थिते । मज्जस्थ एवेत्यपरे प्रभावं स तु दर्शयेत ॥८४॥
Just as poison disappears / gets back into its earlier seat, becoming weak after producing the bouts of poisonous symptoms and gets aggravated again obtaining strength in course of time, o also the poison of the doshas produce fevers. In this way satata and other fevers (santata, anyedyu, trtiyaka and chaturthaka) manifest irregularly (intermitantly). Fever manifests at the specific time when the doshas become strong (increased) and recedes back again, on the strength and weakness (respectively) of factors of hinderance ( restrain ing factors). (75-77)
द्विधा कफेनजङ्गाभ्यां प्रथमं शिरसोऽनिलात् । गम्भीरधातुचारित्वात् सन्निपातेन सम्भवात् ॥८५ ॥
तुल्योच्छ्रायाच्च दोषाणां दुश्चिकित्स्यश्चतुर्थकः ॥८६॥
Chaturthaka jvara is produced by the doshas residing in the channels of medas (fat), majja (marrow) and asthi (bone) or any one of them. Some others say, that it is produced by the doshas residing in majja only. It shows its effect (onset) in two ways, viz, commencing with the calves when kapha (is predominant), and with the head, when vata is predominant. As it resides in deeper tissues and arises, from all the three doshas, all the doshas being equally powerful, chaturthaka (fever every fourth day) is difficult to treat. (84-86)
अस्थिमज्जोभयगते चतुर्थकविपर्ययः । त्रिधा द्व्यहं ज्वरयति दिनमेकं तु मुञ्चति ॥८७॥
Doshas residing in (the channels of) both asthi and majja produce chaturthaka viparyaya jvara. It is of three types (from the predominance of vata, pitta and kapha); fever is present for two days (continuously) and gives relief of one day (commences again for another course). (87)
Notes: In Santata jvara, there is continous fever for 7, 10 or 12 days followed by a short period of remission, and another bout of continous fever for 7, 10 or 12 days. Such bouts may be many. In Satata jvara, there is rise of temperature twice, once in the day and once in the night. In Anyedyu jvara there is rise of temperature only once either during day or night. In Trtiyaka there is fever every alternate day. In chaturthaka there is fever with an interval of two days. and chaturthaka Viparyaya the fever continues for two days, followed by a short gap and recurrance, Visama jvara are remittant fevers such as malaria, kalazar, etc caused by parasites, bacteria, virus etc.
बलाबलेन दोषाणामन्नचेष्टादिजन्मना । ज्वरः स्यान्मनसस्तद्वत्कर्मणश्च तदा तदा ॥८८ ॥
By the strength of weakness of the doshas brought about by the effect offood, activities and actions of past lives etc arises the Manasa jvara (psychic fever) as and when these actions become powerful. (88)
Dhatugata jvara – fever localised in the tissues
उत्कलेशो गौरवं दैन्यं भङ्गोऽङ्गानां विजृम्भणम् । अरोचको वमि: सादः सर्वस्मिन् रसगे ज्वरे ॥८९ ॥ In fever residing in Rasa (dhatu) nausea, feeling of heaviness, timidity, cutting pain in the body parts, excess of yawning, loss of appetite, vomiting and debility are produced. (89)
रक्तनिष्ठीवनं तृष्णा रक्तोष्णपिटकोद्गमः । दाहरागभ्रममदप्रलापा रक्तसंश्रिते ॥१०॥
If residing in Rakta, it (fever) produces expectoration of blood, thirst, appearance of red and hot papules, burning sensation reddish colouration, toxicity and delerium. (90)
तृड् ग्लानिः सृष्टवर्चस्त्वमन्तर्दाहो भ्रमस्तमः । दौर्गन्ध्यं गात्रविक्षेपो मांसस्थे मेदसि स्थिते ॥९१ ॥
If residing in Mamsa, it causes thirst, exhaustion without any effort, elimination of faeces, bad smell ( from the body) and involuntary movement of the body parts. (91)
स्वेदोऽतितृष्णा वमनं स्वगन्धस्यासहिष्णुता । प्रलापो ग्लानिररुचिरस्थिस्थे त्वस्थिभेदनम् ॥ १२ ॥
If residing in Medas it produces perspiration, severe thirst, vomiting, intolerance of his own smell, delerium, exhoustion without any effort and loss of appetite.
Residing in the Asthi, it produces cutting pains in the bones, elimination of doshas both upwards and downwards, increased/difficult breathing, involuntary movements of the body parts and coloing sound from the throat. (92)
दोषप्रवृत्तिरूर्ध्वाधः श्वासाङ्ग क्षेपकूजनम् । अन्तर्दाहो बहि:शैत्यं श्वासो हिध्मा च मज्जगे ॥९३ ॥
Residing in Majja, it causes burning sensation, inside and cold feeling outside, increased/difficult breathing and hiccup. ( 93 )
If it resides in sukra, seeing of darkness before the eyes (temporary blindness), cutting / peircing pain in the vital parts ( spots ), rigidity of the penis of ( or loss of movement in it) elimination of semen (involuntary) and death. (94)
Mild fever daily, dryness, cold (chills), stiffness of the body and predominance of kapha are seen in Vatabalasaka jvara. (97)
तमसो दर्शनं मर्मच्छेदनं स्तब्धमेढ्रता । शुक्रप्रवृत्तिर्मृत्युश्च जायते शुक्रसंश्रये ॥१४॥
उत्तरोत्तरदुस्साध्याः पञ्चात्रान्त्यौ तु वर्जयेत् ।
The above (fevers) are difficult and more difficult to treat in their succeeding order and should be refused at the end of five nights. (95)
प्रलिम्पन्निव गात्राणि लेष्मणा गौरवेण च ।
मन्दज्वर: प्रलेपस्तु सशीतः स्यात्प्रलेपकः ॥९५ ॥
The body smeared with kapha, like a thin paste, feeling of heaviness, mild fever along with cold (chills) are the symptoms of Pralepaka jvara. (96)
नित्यं मन्दज्वरो रूक्षः शीतः कृच्छ्रेण सिध्यति । स्तब्धाङ्गः श्रेष्मभूयिष्ठो भवेद्वातबलासकः ॥९६ ॥
हरिद्राभेकवर्णाभस्तद्वर्णं यः प्रमेहति ।
सवै हारिद्रको नाम ज्वरभेदोऽन्तकः स्मृतः ॥९७॥
The colour of the body resembling that of haridra (turmeric) or a frog, urine also of the same colour is another kind of fever known as Haridraka jvara and is fatal. (98)
कफवातौ समौ यस्य हीनपित्तस्य देहिनः ॥ १८ ॥
तीक्ष्णो वा यदि वा मन्दो जायते रात्रिकोज्वरः । दिवाकराऽऽपीतबले व्यायामाच्च विशोषिते ॥ १९ ॥
When kapha and vata are equal (even in their increase) and pitta is less, the person gets mild or severe fever at nights only, known as Ratrika jvara (nocturnal fever). (99)
शरीरे नियतं वाताज्ज्वरः स्यात् पूर्वरात्रिकः ।
In persons from whose body the sun has sucked all the strength or has gone dry by exercises (physical activities), there appears a fever caused by increased a vata known as Purvaratrika jvara (evening fever). (100)
आमाशये यदा दुष्टे लेष्मपित्ते व्यवस्थिते ॥१०० ॥
तदार्धं शीतलं देहे त्वर्धञ्चोष्णं प्रजायते । काये पित्तं यदा दुष्टं श्रेष्मा चान्ते व्यवस्थितः ॥१०१॥
उष्णत्वं तेन देहस्य शीतत्वं करपादयोः ॥१०२ ॥
When the aggravated (increased) kapha and pitta accumilate in the amasaya (recepticle of undigested food, stomach), then manifests a fever with half of the body being cold and another half being hot.
When pitta gets increased more in the trunk and kapha more in the extremities then the trunk will be hot whereas hands and feet will be cold. (101-102)
Jvaramoksa Lakshana
धातून् प्रक्षोभयन् दोषो मोक्षकाले विलीयते । ततो नरः श्वसन् स्विद्यन् कूजन् वमति चेष्टते ॥१०३ ॥
वेपते प्रलपत्युष्णैः शीतैश्चाङ्गैर्हतप्रभः । विसंज्ञो ज्वरवेगार्तः सक्रोध इव वीक्षते ॥१०४॥
सदोषशब्दञ्च शकृद् द्रवं सृजति वेगवत् ॥१०५॥
At the time of fever leaving the body, the doshas produce havoc in the dhatus and disappear, so the patient suffers greatly from increased difficult breathing, perspiration, cooling sound in he throat, vomiting, involuntary activities and movements of the body parts, delerium, warmth or coldness of the different parts, loss of lustre (colour and complexion), and loss of consciousness, the patient looks like one with great anger (observes others in angry mood), utters bad words, and eliminates watery faeces frequently. (103-105)
देहो लघुर्व्यपगतक्लमममोहताप: पाको मुखे करणसौष्ठवमव्यथत्वम्।
स्वेदः क्षवः प्रकृति योगि मनोऽन्नलिप्सा कण्डूश्च मूर्ध्नि विगतज्वरलक्षणानि ॥१०६॥
A feeling of lightness of the body, absence of exhaustion delusion and distress (of heat), formation of ulcers in the mouth, keenness of the sense organs, absence of discomfort, perspiration, sneezing mind in its normal state, desire for food, and (mild ) itching on the scalp – are the symptoms of Vigata jvara – person relieved of fever. (106)
॥ इति द्वितीयोऽध्यायः ॥
Thus ends the Second chapter.
