Jwara Pratisedha – symptoms and treatment of Fever – Sushrutasamhita Uttaratantra Chapter 39

एकोनचत्वारिंशोऽध्यायःअथातो ज्वरप्रतिषेधं यथोवाच भगवान्ये नामृतमपां व्याख्यास्यामः, धन्वन्तरिः ॥ १ ॥

Now we shall discourse on the (symptoms and medical treatment of Fever (Jwara – Pratisedha). 1.

मध्यादुद्धृतं पूर्वजन्मनि । यतोऽमरत्व सम्प्राप्तास्त्रिदशास्त्रिदिवेश्वरात् । शिष्यास्तं देवमासीनं पप्रच्छुः सुश्रुतादयः ॥ २ ॥

व्रणस्योपद्रवाः प्रोक्ता व्रणिनामप्यतः परम् । समासाद् व्यासतश्चैव ब्रूहि नो भिषजां वर ॥ ३ ॥

उपद्रवेण जुष्टस्य व्रणः कृच्छ्रेण सिध्यति । उपद्रवास्तु व्रणिनः कृच्छ्रसाध्याः प्रकीर्तिताः ॥ ४ ॥

प्रक्षीणबलमांसस्य शेषधातुपरिक्षयात् । तस्मादुपद्रवान् कृत्स्त्रान् ब्रूहि नः सचिकित्सितान् ।

सर्वकायचिकित्सासु ये दृष्टाः परमर्षिणा ॥ ५ ॥

The Divine Dhanvantari, who in his first incarnation arose out of the primordial Ocean with a pitcher of ambrosia on his head, (when it was churned by the gods and the demons) and who conferred immortality on Indra and his brother celestials, was thus interrogated by his disciples, Susruta and others “You had instructed us, O, you, the foremost of physicians, the subject on all the concomitant distressing symptoms (Upadarva) of Ulcer (Vrana ). Now let us have a general outline and detailed description of the concomitant distressing symptoms, physiological and pathological conditons e.g. fever, dysentery, cough, etc. showing in an ulcer patient. An ulcer attended with many a concomitant symptom Upadrava may be cured only with the greatest difficulty and such concomitant symptoms appearing in an emaciated and weak ulcer-patient, take time to be subdued because of the loss of his Dosas and Dhatus. Hence illumine us fully, O sir, on those diseases affecting the whole body (and not localised in any particular limb or organ) observed by the holy sages of yore, and instruct us the nature and application of the therapeutic agents to be employed in their cure.” 2-5.

Description of Jwara

तेषां तद् वचनं श्रुत्वा प्राब्रवीद् भिषजां वरः । ज्वरमादौ प्रवक्ष्यामि स रोगानीकराट् स्मृतः ॥ ६ ॥

रुद्रकोपाग्निसम्भूतः सर्वभूतप्रतापनः । तैस्तैर्नामभिरन्येषां सत्त्वानां परिकीर्त्त्यते ॥ ७ ॥

जन्मादौ निधने चैव प्रायो विशति देहिनः । अतः सर्वविकाराणामयं राजा प्रकीर्तितः ॥ ८ ॥

ऋते देवमनुष्येभ्यो नान्यो विषहते तु तम् । कर्मणा लभते यस्माद् देवत्वं मानुषादपि ॥ ९॥

पुनश्चैव च्युतः स्वर्गान्मानुष्यमनुवर्तते । तस्मात् तेदेवभावेन सहन्ते मानुषा ज्वरम् ।

शेषाः सर्वे विपद्यन्ते तैर्यग्योना ज्वरार्दिताः ॥ १० ॥

Description of Jwara – To the query of the disciples, the divine physicia Dhanvantari_replied as follows— “First I shall discourse on the nature and origin of fever for it is the king of all bodily distempers in as much as it affects the whole organism at a time. It was begotten by the fire of wrath of Rudra and afflicted the whole animal world or organic kingdom. The different names by which it is designated amongst the different kinds of animals are well known. Its presence is perhaps an indispensable condition under which a creature can come into being or can depart from this life, and hence it is called the lord of ailments and none but a god or man can bear the heat of fever. Men may become gods by virtue of their good deeds (Karma) in life and would again revert to humanity (mortality) at the close of their blissful effects and it is this divine or godly element in man that enables him to bear this abnormal heat of fever whereas the lower animals are simply lost under its influence. 6-10.

Definition and Classification of Fever

स्वेदावरोधः सन्तापः सर्वाङ्गग्रहणं तथा । विकारा युगपद् यस्मिन् ज्वरः स परिकीर्तितः ॥ ११ ॥

दोषैः पृथक् समस्तैश्च द्वन्द्वैरागन्तुरेव च । अनेककारणोत्पन्नः स्मृतस्त्वष्टविधो ज्वरः ॥ १२ ॥

Definition and Classification of Fever – The disease which is marked by the arrest of the flow of perspiration, by increased heat (of the skin), by pain all over the body and by a sense of numbness in the limbs, is called Jwara (fever). Cases of fever of which the causes are numerous, are divided into eight types according as they are brought on through the derangement of the three bodily Dosas separately, or through that of any two of them in combination or through their concerted action, or by any extraneous causes.’ 11-12.

दोषाः प्रकुपिताः स्वेषु कालेषु स्वैः प्रकोपणैः । व्याप्य देहमशेषेण दुष्टाः स्वहेतुभिर्दोषाः सहिता ज्वरमापादयन्ति हि ॥ १३ ॥ प्राप्यामाशयमूष्मणा । रसस्वेदप्रवाहिणाम् ॥ १४ ॥ रसमागत्य स्त्रोतसां मार्गमावृत्य मन्दीकृत्य हुताशनम् । निरस्य बहिरूष्माणं पक्तिस्थानाच्च केवलम् ॥ १५ ॥ शरीरं समभिव्याप्य स्वकालेषु ज्वरागमम् । जनयन्त्यथ वृद्धिञ्च स्ववर्णञ्च त्वगादिषु ॥ १६ ॥

When the Dosas of the body are deranged by their respective aggravating causes and in the hours of their specific dominance² they bring on an attack of fever by spreading through the whole organism. The deranged bodily Dosas augmented or enraged by their specific aggravating causes, enter the Amasaya and soon find lodgment in the Rasa (lymph-chyle) by virtue of their inherent heat (Usma). The Dosas thus deranged and mixed with Rasa obstruct the Rasa carrying and sweat-carrying ducts, impair the digestive fire and expel the inherent heat (Usma) out of its seat in the Pakvasaya, and spreading all over the body during the period of their specific dominance, bring on fever and cause its rise and exhibit their specific colour on the skin, etc. (of the patient). 13-16.

1. There can be three cases of fever due to derangement of the three Dosas separately, three cases form the derangement of two of them at a time and one case only fromthe concerted action of the three Dosas. These are the seven cases while that due to an extraneous cause is the eighth.

2. Kapha is aggravated in the morning, Pitta, at noon and Vayu, in the evening. Fever follows a distinct periodicity determined by the time of aggravation of the deranged bodily Dosah ushcring in the attack. An attack of fever due to the deranged Kapha comes on in the morning or after dusk;

Pathology of Fever

मिथ्यातियुक्तैरपि च स्नेहायैः कर्मभिर्नृणाम् । विविधादभिघाताच्च रोगोत्थानात् प्रपाकतः ॥ १७ ॥ श्रमात् क्षयादजीर्णाच्च विषात् सात्म्यर्त्तु पर्ययात् । ओषधीपुष्पगन्धाच्च शोकान् नक्षत्रपीडया ॥ १८ ॥ अभिचाराभिशापाभ्यां मनोभूताभिशङ्कया । स्त्रीणामपप्रजातानां प्रजातानां तथाऽहितैः । स्तन्यावतरणे चैव ज्वरो दोषैः प्रवर्तते ॥ १९ ॥ तैर्वेगवद्भिर्बहुधा समुद्भ्रान्तैर्विमार्गगैः । बहिश्चरः ॥ २० ॥ विक्षिप्यमाणोऽन्तरग्निर्भवत्याशु रुणद्धि चाप्यपांधातुं यस्मात् तस्माज्ज्वरातुरः । ज्वरितस्तेन चोच्यते ॥ २१ ॥ भवत्यत्युष्णगात्रश्च

Pathology — The improper and excessive application of Sneha, etc. any kind of blow, the presence of any other affection in the organism, suppuration ( of an existing boil or ulcer in the body), overfatigue, any process of physical waste, indigestion, introduction of on at noon or midnight, one due to the deranged Vayu comes on in the afternoon or during the last hours of the night. In a case of Dvi-dosaja fever (due to the combined action of the two deranged bodily Doshas) the heat is aggravated during the specific hours of domination of the stronger Dosu and continues through those peculiar to each of them. All might a ttacks should be regarded as connected with the action of the deranged Pitta. In a Tri-dosaja case, the heat comes on with the specific hour of the strongest one and is abated on the approach of the time peculiar to the weakest. Vayu is aggravated in the Varsa ( rainy) season, Pitta, inthe Sarat ( autumn) and Kapha, in the Vasanta (spring). any extraneous poison or poisonous matter into the system, infringement of any habitual rule of diet and conduct, the sudden change or contrariety of seasons, the smelling of any kind of poisonous herb or flower, grief, the malignant influences of inauspicious stars or planets (at the time of birth), dynamics of deadly incantations or charms, curses ( from Brahmans and superiors), any fancied dread or anxiety, effects of miscarriage or untimely parturition, injudicious conduct of life on the part of a woman after delivery, and the first accumulation of the milk in the breast (after delivery) are the causes which lead to an attack of fever, the derangement and aggravation of the fundamental vital principles (Dosas) of the body being the existing origins of the diseases. The stomachic heat is propelled by the extremely deranged and aggravated Dosas of the body, and coursing through the wrong channels in the orgainsm, tends to escape through the surface (the skin of the body) and, by incarcerating the vitiated Rasa Dhatu generally causes a rise in the bodily temperature and puts a stop to perspira-tion. 17-21:

Pemonitory Symptoms of fever

श्रमोऽरतिर्विवर्णत्वं वैरस्यं नयनप्लवः । इच्छाद्वेषौ मुहुश्चापि जृम्भाऽङ्गमर्दो गुरुता अप्रहर्षश्च शीतञ्च भवत्युत्पत्स्यति ज्वरे ॥ २३ ॥ सामान्यतो विशेषात् तु जृम्भाऽत्यर्थं समीरणात् । पित्तान्नयनयोर्दाहः कफान्नान्नाभिनन्दनम् ॥ २४ ॥ सर्वलिङ्गसमवायः सर्वदोषप्रकोपजे । शीतवातातपादिषु ॥ २२ ॥ रोमहर्षोऽरुचिस्तमः । द्वयोर्द्वयोस्तु रूपेण संसृष्टं द्वन्द्वजं विदुः ॥ २५ ॥

Premonitory Symptoms – A sense of fatigue or physical languor, aversion to all sorts of work, paleness of complexion, bad taste in the mouth, tearfulness of the eye, alternate liking and dislike for heat, cold and air, constant yawning, aching of the limbs, a sense of heaviness of the body, horripilation, disrelish for food, darkness of vision, depression and a feeling of creeping cold in the body are the general premonitory symptoms which usher in an attack of fever. Constant yawning, burning of the eyes and aversion to food are the special premonitory symptoms of the derangement of Vayu, Pitta and Kapha respectively. The derangement of all the three Dosas is marked by the presence of all the symptoms, while in the derangement of any two of these, the special symptoms of those two Dosas appear. 22-25.

Symptoms of Vataja fever

वेपथुर्विषमो वेगः कण्ठौष्ठमुखशोषणम् । निद्रानाशः क्षुतः स्तम्भो गात्राणां रौक्ष्यमेव च ॥ २६ ॥

शिरोहृद्गात्ररुग्वक्त्र – वैरस्यं बद्धविकता | जृम्भाऽऽध्मानं तथा शूलं भवत्यनिलजे ज्वरे ॥ २७ ॥

Symptoms of Vataja fever – Shivering, irregular fits of fever, dryness of the throat, lips and of the mouth, loss of sleep, stoppage of sneezing, parchedness of the skin, pain in the head, chest and limbs, distaste in the mouth, suppression (D. R. – hardness) of stool and aching pain (in the abdomen) are the characteristics of a case of fever due to the action of the deranged Vayu of the body. 26-27.

Symptoms of Pittaja fever

वेगस्तीक्ष्णोऽतिसारश्च निद्राल्पत्वं तथा वमिः ।

कण्ठौष्ठमुखनासानां पाकः स्वेदश्च जायते ॥ २८ ॥

प्रलापः कटुता वक्त्रे मूर्छा दाहो मदस्तृषा | पीतविण्मूत्रनेत्रत्वं पैत्तिके भ्रम एव च ॥ २९ ॥

Symptoms of Pittaja fever – High fever (hyperpyrexia) diarrhoea, scanty but disturbed sleep, vomiting, inflamation in the throat, lips, mouth and nostrils, perspiration, delirious talks, swoon of fainting fits, burning sensation in the body, loss of consciousness, pungent taste in the mouth, thirst, yellowness of the stool, urine and of the mouth, yellowness of the stool, urine and of the eyes and vertigo are the symptoms which mark the Pittaja type of fever. 28-29.

गौरवं शीतमुत्क्लेशो स्त्रोतोरोधो रुगल्पत्वं प्रसेको रोमहर्षोऽतिनिद्रता ।

मधुरास्यता । छर्दिरङ्गसादोऽविपाकता। नात्युष्णगात्रता प्रतिश्यायोऽरुचिः कासः कफजेऽक्ष्णोश्च शुक्लता ॥ ३० ॥

Symptoms of the Kaphaja fever – Heaviness of the limbs, shivering, nausea, horripilation, excessive sleep, obstruction of the internal passage of the body, slight pain (in the limbs), water-brash, sweet taste in the mouth, slight heat in the body, vomiting, lassitude, mal-assimilation (Avipakata), whitness (glossinss) of the eyes are the indications which point the Kaphaja origin of the disease. 30.

Symptoms of the Tridosaja fever

निद्रानाशोः भ्रमः श्वासस्तन्द्रा सुप्ताङ्गताऽरुचिः | तृष्णा मोहो मदः स्तम्भो दाहः शीतं हृदि व्यथा ॥ ३१ ॥

पक्तिश्चिरेण दोषाणामुन्मादः श्यावदन्तता । रसना परुषा कृष्णा सन्धिमूर्धास्थिजा रुजः ॥ ३२ ॥

निर्भुग्ने कलुषे नेत्रे कर्णौ शब्दरुगन्वितौ । प्रलापः स्त्रोतसां पाकः कूजनं चेतनाच्युतिः ॥ ३३

स्वेदमूत्रपुरीषाणामल्पशः सुचिरात् स्रुतिः ॥ ३४ ॥

Symptoms of the Tri-dosaja fever – Insomnia, vertigo, laboured and difficult breathing, drowsiness (somnolence), a sense of inertness in the limbs, aversion to food, thirst, swoon, delirium, numbness, burning sensation and shivering of the body, pain about the region of the heart, delayed digestion of the deranged bodily Dosas, ( Temporary ) insanity, blackish yellow coat on the tecth, blackness and roughness of the tongue, pain in the head, in the joints and in the bone, dilatation of the pupil and cloudiness of the eyes, pain and ringing in the ears, delirious talks, inflamation of the living membranes of the channels (of the nose and of the mouth), indistinct sound in the mouth, coma ( loss of consciousness ) as well as perspiration, scanty emission of urine and faecal matter at long intervals, are the symptoms which are exhibited in a case of fever due to the concerted action of all the three deranged Dosas of the body (Tri-dosaja or Sannipataja). 31-34.

Abhinyasa fever

सर्वजे सर्वलिङ्गानि विशेषञ्चात्र मे शृणु ॥ ३५ ॥ नात्युष्णशीतोऽल्पसंज्ञो भ्रान्तप्रेक्षी हतस्वरः । खरजिह्वः शुष्ककण्ठः स्वेदविण्मूत्रवर्जितः ॥ ३६॥ सास्त्रो निर्भुग्ग्रहृदयो भक्तद्वेषी हतप्रभः । श्वसन् निपतितः शेते प्रलापोपद्रवायुतः ॥ ३७॥ तमभिन्यासमित्याहुर्हतौजसमथापरे ✔ सन्निपातज्वरं कृच्छ्रमसाध्यमपरे विदुः ॥ ३८ ॥

Abhinyasa fever – Now hear from me about the peculiar type of fever the symptoms where of are as follows-Where slight or imperceptible rise of the bodily heat, or a slightly subnormal temperature attended with a subcomatose state, erroneous vision, loss of voice, injured or cracked condition of the tongue, dryness of the throat, suppression of stool, perspiration and urine, tearful eyes, hardness of the thorax’, aversion of food, dulness of complexion, difficult breathing and delirious talks and other concomitant symptoms are the specific indications in a patient always confined to his bed, it is known by the name of Abhinyasa, while other call it a case of hataujasa fever. 35-38.

निद्रोपेतमभिन्यासं क्षीणमेनं हतौजसम् । संन्यस्तगात्रं संन्यासं विद्यात् सर्वात्मके ज्वरे ॥ ३९ ॥

An attack of Sannipataja fever can be cured only with the greatest difficulty, while others hold it to be almost incurable. A case of Sannipataja fever attended with somnolence is called Abhinyasa, it is called Hataujasa when the vitality of the patient is greatly diminished and it is called Sannyasa when there is an innertness of the limbs. 39.

ओजो विस्रंसते यस्य पित्तानिलसमुच्छ्रयात् । गात्रस्तम्भशीताभ्यां शयनेप्सुरचेतनः ॥ ४० ॥

स अपि जाग्रत् स्वपन् जन्तुस्तन्द्रालुश्च प्रलापवान् । संहृष्टरोमा स्त्रस्ताङ्गो मन्दसन्तापवेदनः ।

ओजोनिरोधजं तस्य जानीयात् कुशलो भिषक् ॥ ४१ ॥

When (in a case of Sannipataja fever), the Ojo-dhatu (one of the fundamental principles) of the organism being disturbed or agitated by the deranged and aggravated Pitta and Vayu, gives rise to shivering and numbness of limbs and makes the patient drop into fits of unconsciousness whether asleep or awake, and when there are somnolence, delirious talks, horripilation, looseness of the limbs and slight pain (in the body)- this kind of fever is called Ojo-nirodhaja fever (due to an obstruction or an overwhelmed condition of the Ojadhatu) by the experts. 40-41.

1. “साश्रुनिर्भुग्रनयनः” is a different reading in place of “साखी निर्भुग्रहृदय: ” |

The term is more appropriately applicable to than to both grammatically and in sense.

सप्तमे दिवसे प्राप्ते दशमे द्वादशेऽपि वा । पुनर्घोरतरो भूत्वा प्रशमं याति हन्ति वा ॥ ४२ ॥

The disease, (in such cases) finds aggravation on the seventh, the tenth or on the twelfth day’ when the case takes either a favourable turn or ends in death. 42.

Symptoms of Dwandvaja fever

द्विदोषोच्छ्रायलिङ्गास्तु द्वन्द्वजास्त्रिविधाः स्मृताः ॥ ४३ ॥ तृष्णा मूर्च्छा भ्रमो दाहः स्वप्ननाशः शिरोरुजा । कण्ठास्यशोषो वमथू रोमहर्षोऽरुचिस्तमः । पर्वभेदश्च जृम्भा च वातपित्तज्वराकृतिः ॥ ४४ ॥ स्तैमित्यं पर्वणां भेदो निद्रागौरवमेव च। शिरोग्रहः प्रतिश्यायः कासः स्वेदाप्रवर्त्तनम् । सन्तापो मध्यवेगश्च वातश्लेष्मज्वराकृतिः ॥ ४५ ॥ लिप्ततिक्तास्यता तन्द्रा मोहः कासोऽरुचिस्तृषा | मुहुर्दाहो मुहुः शीतं श्लेष्मपित्तज्वराकृतिः ॥ ४६ ॥

Symptoms of Dwandvaja fever – A case of fever which involves, and is due to the combined action of any two deranged Dosas of the body, is called Dwandvaja fever and such cases are classified into three different types (e.g. Vata-pitta-fever, Vata-slesma-fever and Pitta-slesma-fever ). Yawning, vomiting, loss of consciousness, horripilation pain in the joints, thirst, insomnia, giddiness and heat or increased temperature of the skin, are the characteristic symptoms of Vata-pitta fever (due to the action of the deranged Pitta and Vayu ). Aching pain (sula), cough the vomiting of Kapha, shivering, coryza, cold, sense of haviness of the limbs, aversion to food, and a feeling of general numbness, are the symptoms of a case of Vata-slesma-fever (due to the action of th deranged Vayu and Kapha). Oral cavity covered with kapha and having pungent taste sensation of cold and heat, aversion to food, numbness, perspiration, epileptic fits, unconsciousness, vertigo, cough, lassitude and nausea are the symptoms which characterise a case of Pitta-slesma-fever (due to the action of the deranged Pitta and Kapha ) 1 43-46.

1. The fever in which Vayu predominates gets aggravated on the 7th day that in which Pitta predominates becomes aggravated on the loth day and that in which Kapha predominates gets to be aggravated on the 12th day. According to some authority, however, Abhinyasa, Hataujasa, and Sannyasa types of fever are pacified on the 7th, 10th and 12th day respectively. Dalhana.

क्षामाणां ज्वरमुक्तानां मिथ्याहारविहारिणाम् । दोषः स्वल्पोऽपि संवृद्धो देहिनामनिलेरितः ॥ सततान्येद्युष्कत्र्याख्यचातुर्थान् सप्रलेपकान् । कफस्थानविभागेन यथासङ्ख्यं करोति हि ॥ अहोरात्रादहोरात्रात् स्थानात् स्थानं प्रपद्यते । ततश्चामाशयं प्राप्य दोषः कुर्याज्ज्वरं नृणाम् ॥ तथा प्रलेपको ज्ञेयः शोषिणां प्राणनाशनः । दुश्चिकित्स्यतमो मन्दः सुकष्टो धातुशोषकृत् ॥ २२ ॥ कफस्थानेषु वा दोषस्तिष्ठन् द्वित्रिचतुर्षु वा । विपर्ययाख्यान् कुरुते विषमान् कृच्छ्रसाधनान् ॥ २३ ॥

Even a small residue of the deranged bodily Dosas in a patient just cured of an attack of fever but still sufferring from weakness and indulging in injudicious regimen of diet and rule of conduct, it apt to be augmented and aggravated by the deranged Vayu of the body, and thus begets five different types of fever lodged in any of the five specific location of Kapha². These five types are known as the Satata, Anyedyuska, Tritiyaka, Caturthaka and the Pralepaka 3. The (residue of the) deranged Dosa of the body, shifting from one location of Kapha to the next in the course of the entire day and night, ultimately finds lodgment in the Amasaya (stomach) and thus brings on the virulent attack of (those) fevers. Of these the type known as the Pralepaka appears in cases of Sosa (Consumption) and though its attak is a mild one, it puts almost insurmountable difficulties in the way of its cure, brings about a loss of waste of Dhatu (the seven fundamental principles of the organism) and thus ultimately ends in death. There are cases of Visama-jawara known as the Viparyaya type (reverse of the above type) which are the result of the deranged bodily Dosas being simultaneously located in two, three or four specific seats of the deranged bodily Kapha and are hard to cure. 47-51.

1. Dalhana in his commentary has quoted in eight lines with different wordings the symptoms of these kinds of Dwandvaja fever and these lines have been adopted by Madhava in his Nidana. The lines when transtated would be thus- thirst, unconsciousness, vertigo, burning sensaton, somnolence, pain in the head, dryness of the mouth and of the throat, vomiting, horripilation, disrelish for food, giddiness, pain in the joints, and yawning are the symptoms of Vata-pitta-fever. Sensation of moisture (स्तिमित) all over the body, pain in the joints, excessive sleep, heaviness of the limbs, pain in the head, catarrh, cough, scanty perspiration, slight sensation of heat, and pulsation not too quick nor too slow, are the symptoms of Vata-slesma fever. A bitter taste, a coating on the mouth, somnolence, unconsciousness, cough, disrelish for food, thirst, alternate and varying sensation of heat and cold are the symptoms of Slesma-pitta-fever.

2. The five locations of Kapha are the amasaya, chest, throat, head and the joints. 3. There is another kind of Visana Jwara named Santata (cf. Sloka 31 of this Chapter ) and Dalhana remarks that it is begotten when the residue of deranged Dosa is lodged in all the five seats of kapha.

स्वभावो वा विषमे परो हेतुः आगन्तुश्चानुबन्धो fe प्रायशो कैश्चिदीरितः । विषमज्वरे ॥ ५२ ॥ वाताधिकत्वात् प्रवदन्ति तज्ज्ञास्तृतीयकञ्चापि चतुर्थकञ्च । औपत्यके मद्यसमुद्भवे च हेतुं ज्वरे पित्तकृतं वदन्ति । ५३ ॥ प्रलेपकं वातबलासकञ्च कफाधिकत्वेन वदन्ति तज्ज्ञाः । मूर्च्छानुबन्धा विषमज्वरा ये प्रायेण ते द्वन्द्वसमुत्थितास्तु ॥ ५४॥

Several authorities hold Visama Jvara to be suigeneris in its origin. But whether spontancously idiopathic or not, an extraneous fact (either a passing psychic condition such as fear, grief, etc. or the presence of any foreign poisonous matter in the system) is always involved in and intimately connected with a case of Visama fever. The pre-dominance of the deranged and aggravated Vayu is marked in cases of Trtiyaka (tertian) and Caturthaka (quartan coming on every fourth day) fevers. A case of fever due to the abuse of any wine or ardent spirits as well as the one occuring in a low land at the foot of a mountain, should be supposed to involve a predominant action of the deranged and aggravated Pitta. A case of Pralepaka fever is due to the concerted action of the deranged and aggravated Vayu and Kapha, of which the action of the latter should be regarded as more dominant. Cases of Visama fever ushered in by epileptic fits should be regarded as the result of the concerted action of any two deranged Dosas of the body. 52-54.

त्वक्स्थौ श्लेष्मानिलौ शीतमादौ जनयतो ज्वरे । तयोः प्रशान्तयोः पित्तमन्ते दाहं करोति च ॥ ५५ ॥ करोत्यादौ तथा पित्तं त्वक्स्थं दाहमतीव च । प्रशान्ते कुरुतस्तस्मिन् शीतमन्ते च तावपि ॥ ५६ ॥ द्वावेतौ दाहशीतादी ज्वरौ संसर्गजौ स्मृतौ । दाहपूर्वस्तयोः कष्टः कृच्छ्रसाध्यतमः स्मृतः ॥ ५७ ॥ प्रसक्तश्चाभिघातोत्थश्चेतनाप्रभवस्तु यः ॥ ५८ ॥

The deranged Kapha and Vayu of the body, if located under the surface of the skin, produce cold (Shivering) during the first stage of fever, while the deranged Pitta brings on the characterstic burning sensation at its latter stage after the subsidence of the deranged Kapha and Vayu. In certain cases the burning sensation is engendered by the deranged Pitta at the outset, cold (shivering) being brought on by the deranged Kapha and Vayu at the latter stage after the subsidence of the deranged Pitta. Both these two types of fever are brought on through the combined action of two deranged Dosas of the body and of these two, the type which is ushered in by a burning sensation in the body is extremely hard to cure. A case of continued fever resulting from an abnormal psychic condition (such as anger, grief, desire, etc.) or due to any blow or hurt is likewise hard to cure. 55-58.

रात्र्यह्रोः षट्सु कालेषु कीर्तितेषु यथा पुरा । प्रसह्य विषमोऽभ्येति मानवं बहुधा ज्वरः । स चापि विषमो देहं न कदाचिद् विमुञ्चति ॥ ५९ ॥ ग्लानिगौरवकार्येभ्यः स यस्मान्न प्रमुच्यते । वेगे तु समतिक्रान्ते गतोऽयमिति लक्ष्यते ॥ ६० ॥ धात्वन्तरस्थो लीनत्वान्न सौक्ष्म्यादुपलभ्यते । अल्पदोषेन्धनः क्षीणः क्षीणेन्धन इवानलः ॥ ६१ ॥

Fever of the Visama type attacks a man in various ways and follows a distinct periodicity, it being aggravated during the six specific times of dominance of the deranged bodily principles (Dosas) as mentioned before¹ in the course of day and night. This Visama fever never finds complete remission, (but lurks in the deeper organic principles of the body) and produces a sense of physical langour and heaviness of the limbs as well as the characteristic emaciation. It is called Visama-jwara because its abatement is always confounded with its cure and remission, and this confounding is due to the fact that the disease (fever) lies dormant in a very small degree in the deeper principles of the vital organism to be potent only at the slightest exciting cause, just as a feeble fire fed with an insufficient supply of fuel, becomes potent at the slightest exciting cause. 59-61.

1. See chapter XXI— Sutra-sthana.

Seat of Visama Jwara

दोषोऽल्पोऽहितसम्भूतो ज्वरोत्सृष्टस्य वा पुनः । धातुमन्यतमं प्राप्य करोति विषमज्वरम् ॥ ६२ ॥ सततं रसरक्तस्थ: सोऽन्येद्युः पिशिताश्रितः । मेदोगतस्तृतीयेऽह्नि त्वस्थिमज्जगतः पुनः ॥ ६३ ॥ कुर्याच्यातुर्थकं घोरमन्तकं रोगसङ्करम् । केचिद् भूताभिषङ्गोत्थं ब्रुवते विषमज्वरम् ॥ ६४ ॥

Seat of Visama Jwara — Even a small residue of the deranged bodily Dosa, lurking in the system after the apparent cure of fever, is aggravated by a course of injudicious conduct and indifference to strict regimen of diet, and thus invities a fresh attack¹ which is known as the Visama Jwara. A case of Santata (remittent or continuous) fever has its seat in the vitiated Rasa (serum) and blood² of the organism; while a case of Anyedyuska finds location in the contaminated flesh of the body. The type known as the Trtiyaka (tertian-fever coming on every third day) affects the principle of Meda (fat), while the one called Caturthaka (quartan-fever coming on every fourth day) affects and is infiltrated into bones and marrow. The last named type is very dangerous. It brings on a simultaneous attack of several other diseases and often terminates fatally. Several authorities include cases of fever due to the malignant influence of evil spirits within the category of Visama Jwara. 62-64.

1. A case of fever may lapse into a Visama type even from the very commencement of the attack.

2. Vijaya Raksita, the commentator of Madhava Nidana, says, on the authority of Carak, that by the term Santata is meant here both Santata and Satataka and that they have their origin in the vitiated Rasa and blood respectively.

Duration of Visama Jwara

सप्ताहं वा दशाहं वा द्वादशाहमथापि वा । सन्तत्या योऽविसर्गी स्यात् सन्ततः स निगद्यते ।। ६५ ।।

अहोरात्रे सततको द्वौ कालावनुवर्तते । अन्येद्युष्कस्त्वहोरात्रादेककालं प्रवर्त्तते । तृतीयकस्तृतीयेऽह्नि चतुर्थेऽह्नि चतुर्थकः ॥ ६६ ॥

Duration of Visama Jwara – The type of fever which continues for seven, ten or twelve days without any break or remission, is called Santata. A case of Satataka fever is characterised by two distinct aggravations in the course of day and night. Fever of the Anyedyuska type comes on only once a day and one of the Trtiyaka type comes on every third i.e. on every alternate day, while a case of Caturthaka fever sets in every fourth day. 65-66.

Infulence of Vayu on Visama Jvara

वातेनोदीर्यमाणाश्च हीयमाणाश्च एकद्विदोषा मर्त्यानां सर्वतः । तस्मिन्नेवोदितेऽहनि । वेलां तामेव कुर्वन्ति ज्वरवेगे मुहुर्मुहुः ॥ ६७ ॥

( वातेनोद्धूयमानस्तु यथा पूर्येत सागरः । वातेनोदीरितास्तद्वत् दोषाः कुर्वन्ति वै ज्वरान् ॥ ६८ ॥

यथा वेगागमे वेलां छादयित्वा महोदधेः । वेगहानौ तदेवाम्भस्तत्रैवान्तर्निलीयते ॥ ६९ ॥

दोषवेगोदये तद्वदुदीर्येत ज्वरोऽस्य वा । वेगहानौ प्रशाम्येत यथा (न्तः )म्भः सागरे तथा ) ॥ ७० ॥

Infulence of Vayu on Visama Jvara – Just as the ocean is overflown when its waves are swollen up by the gusts of wind (Vayu), so the bodily Dosas are aggravated by the bodily Vayu, and gives rise to different kinds of fever. Just as the water of the occean floods the shore at flowtide and rolls back to its former place during ebb-tide, so fever being augmented by the deranged Dosas of the body, rushes out of its lurking place in the organism and manifests itself (or comes to the surface of the skin) during the hours of the specific aggravation of the Dosas, only to be driven back into the deeper tissues and vital principles of the body during the period of their principles of the body during the period of their specific abatement, or to be expelled from the organisim at the completion of their perfect assimilation in or elimination from the system. 67-70.

Agantuka Jwara

विविधेनाभिघातेन ज्वरो यः सम्प्रवर्तते । यथादोषप्रकोपन्तु तथा मन्येत तं ज्वरम् ॥ ७१ ॥ श्यावास्यता विषकृते दाहातीसारहृद्ग्रहाः । अभक्तरुक् पिपासा च तोदो मूर्च्छा बलक्षयः ॥ ७२ ॥ ओषधीगन्धजे मूर्च्छा शिरोरुक् वमथुः क्षवः ॥ ७३ ॥ कामजे चित्तविभ्रंशस्तन्द्राऽऽलस्यमरोचकः । हृदये वेदना चास्य गात्रञ्च परिशुष्यति ॥ ७४ ॥ भयात् प्रलापः शोकाच्च भवेत् कोपाच्च वेपथुः ॥ ७५ ॥ अभिचाराभिशापाभ्यां मोहस्तृष्णाऽभिजायते । भूताभिषङ्गादुद्वेग-हास्यकम्पनरोदनम् ॥ ७६॥

Agantuka Jwara – A case of fever due to any extraneous blow or injury should be treated in the light of its periodicity and aggravation or in other words the nature of the deranged bodily Dosas underlying, or involved in such a case should be ascertained from the periodicity of its aggravation. A case of fever due to the effects of poison is marked by such symptoms as blackness of the face, burning sensation, diarrhoea, catching pain in the region of the heart, aversion to food, thirst, piercing pain in the limbs, epileptic fits and extreme weakness. A case of fever caused by smelling the pollens of any kind of (strong smelling) herbs (as Hay fever) is marked by fainting fits, pain in the head, vomiting and sneezing. A case of fever incidental to an ungratified amorous longing of the heart, or due to any such ardent passion is characterised by aberration or distracted state of the mind, drowsiness, languidness, aversion to food, pain at the cardic region and a speedy emaciation of the body. Delirium marks a case of fever due to grief or terror and shivering characterises one due to a fit of anger. Thirst and fainting fits are the concomitants of a case of fever due to any curse, or ushured in through the dynamics of deadly incantations. Anxiety, laughter, shivering and weeping mark a case due to the malignant influence of evil spirit. 71-76.

श्रमक्षयाभिघातेभ्यो देहिनां कुपितोऽनिलः । पूरयित्वाऽखिलं देहं ज्वरमापादयेद् भृशम् ॥ ७७॥ रोगाणान्तु समुत्थानाद् विदाहागन्तुतस्तथा । ज्वरोऽपरः सम्भवति तैस्तैरन्यैश्च हेतुभिः । दोषाणां स तु लिङ्गानि कदाचिन्नातिवर्तते ।। ७८ ।।

The bodily Vayu deranged and aggravated by fatigue, physical waste or by a blow spreads through the entire organism and begets (Traumatic) fever. There is another kind of fever which is due to any extraneous cause or which results from the acute stage of any other disease attending on the body. It exhibits all the symptoms characteristic of each of the deranged bodily Dosas involved therein. 77-78.

गुरुता हृदयोत्क्लेश: सदनं छर्घरोचकौ । रसस्थे तु ज्वरे लिङ्गं दैन्यञ्चास्योपजायते ॥ ७९ ॥ रक्तनिष्ठीवनं स्वेदश्छर्दनविभ्रमौ । दाहः प्रलापः पिटिका तृष्णा रक्तप्राप्ते ज्वरे नृणाम् ॥ ८० ॥ पिण्डिकोद्वेष्टनं तृष्णा सृष्टमूत्रपुरीषता । ऊष्माऽन्तर्दाहविक्षेपौ ग्लानिः स्यान्मांसगे ज्वरे ॥ ८१ ॥ भृशं स्वेदस्तृषा मूर्च्छा प्रलापश्छर्दिरेव च । दौर्गन्ध्यारोचकौ ग्लानिर्मेद:स्थे चासहिष्णुता ॥ ८२ ॥ भेदोऽस्थनां कुञ्च (ज)नं श्वासो विरेकश्छर्दिरेव च । विक्षेपणञ्च गात्राणामेतदस्थिगते ज्वरे ॥ ८३ ॥ तमः प्रवेशनं हिक्का कासः शैत्यं वमिस्तथा । अन्तर्दाहो महाश्वासो मर्मच्छेदश्च मज्जगे ॥ ८४ ॥ मरणं प्राप्नुयात् तत्र शुक्रस्थानगते ज्वरे । शेफसः स्तब्धता मोक्षः शुक्रस्य तु विशेषतः ॥ ८५ ॥ दग्ध्वेन्धनं यथा वह्निर्धातून् हत्वा यथा विषम् । कृतकृत्यो व्रजेच्छान्तिं देहं हत्वा तथा ज्वरः ॥ ८६ ॥

1. ” Abhicar”, means incantations or Atharvan rites by which diseases, death and any other injuries are brought about.

“Abhisapa” means the curse pronounced by Brahmins, preceptors seniors and alters possesed of puissance.

Characteristic symptoms of fever located in different Dhatus

वातपित्तकफोत्थानां ज्वराणां लक्षणं यथा । तथा तेषां भिषग् ब्रूयाद् रसादिष्वपि बुद्धिमान् ॥ ८७ ॥ समस्तैः सन्निपातेन धातुस्थमपि निर्दिशेत् । द्वन्द्वजं द्वन्द्वजैरेव दोषैश्चापि वदेत् कृतम् ॥ ८८ ॥ गम्भीरस्तु ज्वरो ज्ञेयो ह्यन्तर्दाहेन तृष्णया । आनद्धत्वेन चात्यर्थ श्वासकासोद्गमेन हतप्रभेन्द्रियं च ॥ ८९ ॥ क्षीणमरोचकनिपीडितम् । परिवर्जयेत् ॥ ९० ॥ गम्भीरतीक्ष्णवेगार्तं ज्वरितं

Characteristic symptoms of fever located in different Dhatus ( elemental tissues) of the body – Heaviness, cardiac discomfort, lassitude, vomiting, non relish to food and pitifulness are the characteristic features of fever located in Rasa Dhatu (lymph of chyle). Haemoptysis, burning sensation, perspiration, vomiting, giddiness, delirium, appearance of pimples and thirst are the characteristic features of fever located in Rakta Dhatu (Blood). Cramps in calf muscles, thirst, increased excretion of stool and urine, raised heat in the body, feeling of burning sensation in the innerpart of the body, convulsions, unpleasant state of mind are the symptoms of fever located in Mansa Dhatu (muscular tisses ). Exessive perspiration, thirst, fainting, delirium, vomiting, foul smell of the body and non relish to food are the characteristic features of fever located in Medo Dhatu (Adipose tissue). Cracking pain in the bones, contraction of muscles, asthma, purgation, vomiting and convulsions in the body are the symptoms of fever located in Asthi Dhatu (Bonytisse ). Feeling of being submerged in darkness, Hiccough, cough, coldness, vomiting, burning sensation in the inner part of the body, Mahaswasa (Aggravated state of Asthma), piercing pain in vital parts of the body are the symptoms of fever located in Majja Dhatu (Bone Marrow ). Numbness of penis and emission of semen particularly are the symptoms of fever located in Sukra Dhatu (semen) and later on patient dies.

As fire gets extinguished after burning the wood and poison destructs the all Dhatus (elemental timues) of the body, similarly the fever gets pacificel after destroying the body.

As there are characteristic features of fever origined from Vata, Pitta & Kapha in the same manner the mixed features are found in the fever located in two Dhatus as mentioned by wise physicians. While as all characteristic features of Vata, Pitta of Kapha are found in Sonnipata Jwara (fever caused by three Dosas) in the same manner all characteristic features are found in fever located in all of bodily Dhatus (all elemental body tissues).

Gambhira fever and its prognosis

Gambhira fever and its prognosis – A case of Gambhira fever is characterised by a feeling of internal burning sensation in the body (which is not complained of in the surface), thirst, suppression of the stool, painful breathing and cough. Paleness of the complexion, dulness of the sense-organs, emaciation of the body, depression of the mind¹ and presence of supervening symptoms (e.g. difficult breathing, cough, etc.) in cases of both Gambhira (inward or latent) and Tiksna (high) fever are the indications which point to the hopeless nature of the case. 79-90.

हीनमध्याधिकैर्दोषैस्त्रिसप्तद्वादशाहिकः । 1 ज्वरवेगो भवेत् तीव्रो यथापूर्वं सुखक्रियः ॥ ९१ ॥

कालोह्येष यमश्चैव नियतिर्मृत्युरेव च । तस्मिन् व्यपगते देहाज्जन्मेह पुनरुच्यते । इति ज्वराः समाख्याताः कर्मेदानीं प्रवक्ष्यते ॥ ९२ ॥

A slightly, middling or excessively aggravated condition of the deranged Dosas of the body forebodes the continuace of fever for three, seven and twelve days respectively, each succeeding one being more difficult to cure than the one immediately preceding it in order of enumeration. Thus we have done with the description of (the nature, causes and symptoms of) the different types of fever. We shall now deal with the remedial measures or therapeutic agents to be employed in these cases. 91-92.

ज्वरस्य पूर्वरूपेषु वर्तमानेषु बुद्धिमान् । पाययेत घृतं स्वच्छं ततः स लभते सुखम् ॥ ९३ ॥

1. Dalhana says in his commentary that some read a few additional lines after this. He, however, does not comment on those lines and further adds that Jejjata does not read them. So we, too, refrain from translating those lines.

Fever Ayurvedic Treatment

विधिर्मारुतजेष्वेष पैत्तिकेषु विरेचनम् । मृदु प्रच्छर्दनं तद्वत् कफजेषु विधीयते ॥ ९४ ॥ सर्वद्विदोषजेषूक्तं यथादोषं विकल्पयेत् । अस्नेहनीयोऽशोध्यश्च संयोज्यो लङ्घनादिना ॥ ९५ ॥

Treatment — Draughts of filtered (matured but non-medicated) clarified butter should be given as soon as the premonitory symptoms would make their appearance and the patient would get relief thereby. This is applicable only in a case of the Vataja type of fever while purgatives should be administered in a case of the Pittaja, and mild emetics in case of the Kaphaja type under similar conditions. In cases of Dwidosaja and Tridosaja fevers, the foregoing measures should be adopted according to the Dosas involved in each case. In the cases in which emulsive measures (Sneha-Karma) and exhibition of purgatives and emetics are forbidden, such measures should be employed as would tend to lighten the system such as fasting, (Langhana) etc. 93-95.

Fasting

रूपप्रागुरूपयोर्विद्यान्नानात्वं वह्निधूमवत् । प्रव्यक्तरूपेषु हितमेकान्तेनापतर्पणम् ॥ ९६ ॥ आमाशयस्थे दोषे तु सोत्क्लेशे वमनं परम् । आनद्धः स्तिमितैर्दोषैर्यावन्तं कालमातुरः । कुर्यादनशनं तावत् ततः संसर्गमाचरेत् ॥ ९७ ॥

Fasting – The premonitory and the actual stages of fever are of various forms like those of fire and its fume. Fasting is pre-eminetly the best remedy as soon as the characteristic symptoms of the disease make their appearance distinctly and vomiting is most efficacious in a case marked by the presence of the deranged bodily Dosa in the Amasaya (stomach) and attended with nausea, thirst, water-brash. Fasting should be continued as long as the least quantity of the deranged Dosa or Dosas would remain intact in the organism and light food should then be given with discretion after the Dosas have been fully assimilated in (to) the sysmtem. 96-97.

Prohibition of Fasting

न लङ्घयेन्मारुतजे क्षयजे मानसे तथा । अलङ्ख्याश्चापि ये पूर्व द्विव्रणीये प्रकीर्तिताः ॥ ९८ ॥

Prohibition of Fasting – Fasting is prohibited in a case of fever due to a wasting process in the body or incidental to the action of the deranged bodily Vayu or appearing in consequence of any serious state of the mind (e.g. lust, anger, grief, etc.) as well as in cases in which fasting has been forbidden as in the chapter on Dvi-vrana (Chapter I 25-Chikitsa-sthana) 98.

Effect of Fasting

अनवस्थितदोषाग्नेर्लङ्घनं दोषपाचनम् । ज्वरघ्नं दीपनं काङ्क्षा-रुचिलाघवकारकम् ॥ ९९ ॥

Effect of Fasting — Fasting in the case of a patient in whom the bodily Dosas have been deranged and of whom the digestive fire has become dull, lead to an assimilation of the deranged Dosas and kindles the digestive fire, produces remission of fever, lightness of the body and relish for food. 99.

Satisfactory and excessive fasting

सृष्टमारुतविण्मूत्रं क्षुत्पिपासाऽसहं लघुम् । प्रसन्नात्मेन्द्रियं क्षामं नरं विद्यात् सुलङ्गितम् ॥ १०० ॥ बलक्षयस्तृषा शोषस्तन्द्रानिद्राभ्रमक्लमाः । उपद्रवाश्च श्वासाद्याः सम्भवन्त्यतिलङ्घनात् ॥ १०१ ॥

Satisfactory and excessive fasting – Easy and natural passing of Vayu and stool and urine, intolerable keenness of thirst and appetite, lightness of the body, bright, action of the mind and the sense-organs and a weakness of the body are the results which spring form Satifactory fasting; while such symptoms as loss of strength, thirst, dryness (of the mouth), insomnia, verti diziness, fatigue and such other supervening symptoms (as difficult breathing, cough, fever, hic-cup) mark an excessive, fasting. 100-101.

Boiled water

दीपनं कफविच्छेदि पित्तवातानुलोमनम् । कफवातज्वरार्तेभ्यो हितमुष्णाम्बु तृच्छिदम् ॥ १०२ ॥ तद्धि मार्दवकृद्दोष-स्रोतसां शीतमन्यथा | सेव्यमानेन तोयेन ज्वरः शीतेन वर्धते ॥ १०३ ॥

Tepid water-Tepid (boiled water is appetising and it tends to distintegrate the accumulation of Kapha and restores deranged bodily Pitta and Vayu to their normal condition. The use of tepid water which allays thirst is highly efficacious in cases of fever due to the actions of the deranged bodily Kapha and Vaya, as it tends to cleanse the internal passages of the body and helps in the easy movement of the deranged bodily Dosas in the organism. The effect of cold water is just the reverse and its inherent cold tends to aggravate fever. 102-103.

Peya

॥ १०४॥ पित्तमद्यविषोत्थेषु शीतलं तिक्तकैः शृतम् । गाङ्गेयनागरोशीर-पर्पटोदीच्यचन्दनैः दीपनी पाचनी लघ्वी ज्वरार्तानां ज्वरापहा | अन्नकाले हिता पेया यथास्वं पाचनैः कृता ॥ १०५ ॥ बहुदोषस्य मन्दाग्नेः सप्तरात्रात् परं ज्वरे । लङ्घनान्ते यवागूभिर्यदा दोषो न पच्यते ॥ १०६ ॥ तदा तं मुखवैरस्य – तृष्णारोचकनाशनैः । कषायैः पाचनैहृद्यैर्ज्वरघ्यैः समुपाचरेत् ॥ १०७॥

Peya- A potion consisting of water boiled with the admixture of the following bitter drugs viz. Gangeya (Musta), Nagara, Usira, Parpata, Udicya (Balaka) and red sandal-wood should be given when cooled for drinking in a case of pittaja fever, as well as in one due to the effect on any liquor or poison’. A Peya prepared with digestive drugs should be given to the patient when hungry in as much as it is digestive, appetising, light and febrifugal. Tasteful decoctions of digestive, drugs, which alleviate thirst, remove bad taste in the mouth, bring about a fresh relish for food and prove remedial for fever, should be given after the seventh day in a case of fever which, in consequence of a plethora of deranged Dosa in the system, would not abate even after the observance of fasting and the subsequent use of Yavagu and “where the digestive power of the patient has been impaired. 104-107.

पञ्चमूलीकषायन्तु पाचनं पवनज्वरे । सक्षौद्रं पैत्तिके मुस्त- कटुकेन्द्रयवैः कृतम् ॥ १०८ ॥

1. According to different authors purely boiled water, when cooled, may also be given in such cases.

पिप्पल्यादिकषायन्तु कफजे परिपाचनम् । द्वन्द्वजेषु तु संसृष्टं दद्यादथ विवर्जयेत् । पीताम्बुर्लङ्घितो भुक्तोऽजीर्णी क्षीणः पिपासितः ॥ १०९ ॥

A decoction of Panca-mula assimilates the bodily Dosa in a case of Vataja fever, while a decoction of Musta, Katuka and Indrayava mixed with honey (when cold) proves curative in a case of Pittaja fever, and a decoction of the component drugs of the Pippalyadi gorup helps the assimilation on the deranged bodily Dosa in case of Kaphaja fever. Decoctions remedial to each of the deranged bodily Dosas should be administered in combination in a case of fever due to the concerted action of any two deranged Dosas of the body. A decoction should not be given to a patient immediately after eating, drinking or fasting, nor to a patient afflicted with thirst, extreme weakness, emaciation and indigestion. 108-109.

Symptoms of Sama Dosa Jwara

तीक्ष्णे ज्वरे गुरौ देहे विबद्धेषु मलेषु च । सामदोषं विजानीयाज्ज्वरं पक्कमतोऽन्यथा ॥ ११० ॥

मृदौ ज्वरे लघौ देहे प्रचलेषु मलेषु च । पक्वं दोषं विजानीयाज्वरे देयं तदौषधम् । दोषप्रकृतिवैकृत्यादेकेषां पक्कलक्षणम् ॥ १११ ॥

Symptoms of Sama Dosa Jwara – High fever, heaviness in the body and restricted excertion of Malas (waste product of the body) e.g. stool, urine, sweet etc. are the features of Sama Jwar. Just coutrary to these features the symptoms of Pakva Jwara.

Symptoms of Pakva jwara

Symptoms of Pakva-jwara — Abatement of the bodily heat, lightness of the body and an easy passing of stool and urine are the indications from which the assimilation of the deranged bodily Dosas should be presumed, and it is then that febrifuges should be administered according to the nature of the deranged bodily Dosas underlying the case under treatment.1 Some, however, believe that the assimilation of the deranged Dosas should be presumed from the changes in the symptoms characteristic of the Dosas. 110-111.

1. Some read these two lines in a different way. They would mean that the nonassimilation (Ama) of the deranged Dosas would be presumed by the presence of high fever, heaviness of the body and stoppage of the excreta (Mala), and reverse to this is the sign of their assimilation (Paka).

Symptoms of Ama Jwara

हृदयोद्वेष्टनं तन्द्रा लालास्स्रुतिररोचकः । दोषाप्रवृत्तिरालस्यं विबन्धो बहुमूत्रता ॥ ११२ ॥

गुरूदरत्वमस्वेदो न पक्तिः शकृतोऽरतिः । स्वापः स्तम्भो गुरुत्वञ्च गात्राणां वह्निमार्दवम् ॥ ११३ ॥

मुखस्याशुद्धिरग्लानिः प्रसङ्गी बलवान् ज्वरः । लिङ्गैरेभिर्विजानीयाज्ज्वरमामं विचक्षणः ॥ ११४ ॥

Symptoms of Ama-Jwara – A crushing sensation in the region of the heart, drowsiness, salivation, aversion to food, non-assimilation of the deranged bodily Dosas, suppression of stool (and wind), copious discharge of urine, laziness, sense of heaviness in the abdomen, stoppage of perspiration, undigested stool, restlessness, somnolence, heaviness and numbness of the limbs, dulness of digestive fire, bad taste in the mouth, a sense of physical languor and increased virulence and continuity of the attack of fever (abnormal rise in the bodily temperature) are the symptoms by which a learned physician should ascertain the undigested state of the deranged bodily Dosas ushering in an attack of fever. 112-114.

Time for administering Medicine in Fever

inसप्तरात्रात् परं केचिन्मन्यन्ते देयमौषधम् । दशरात्रात् परं केचिद् दातव्यमिति निश्चिताः ॥ ११५ ॥ पैत्तिके वा ज्वरे देयमल्पकालसमुत्थिते । अचिरज्वरितस्यापि देयं स्याद् दोषपाकतः ॥ ११६ ॥ भेषजं ह्यामदोषस्य भूयो ज्वलयति ज्वरम् । शोधनं शमनीयन्तु करोति विषमज्वरम् ॥ ११७ ॥

Time for administering Medicine – According to several authorities, medicines (febrifuges) should be given in a case of fever after the seventh, or according to others after the tenth day of the attack. Febrifuges may be administered earlier in the cases of Pittaja fever, or in the event of the deranged bodily Dosas being digested earlier. An administration of (febrifugal) medicine in an undigested stage of the fever is sure to produce a recrudescence of the disease. Corrective, purifying and soothing (Samaniya) remedies (in case of fever with undigested Dosa) helps the lapse of the disease (fever) into a Visama type. 115-117.

च्यवमानं ज्वरोत्क्लिष्टमुपेक्षेत मलं सदा । अतिप्रवर्तमानच साधयेदतिसारवत् ॥ ११८ ॥

The spontaneous motions of the bowels (Mala) of a patient suffering from fever should not be stopped unless they are excessive, when the case should be medically treated as one of Atisara (Diarrhea) 55.

Preliminary Treatment of fever

यदा कोष्ठानुगाः पक्का विबद्धाः स्त्रोतसां मलाः । अचिरज्वरितस्यापि तदा दद्याद् विरेचनम् ॥ ११९ ॥ पक्को ह्यनिर्हतो दोषो देहे तिष्ठन् महात्ययम् । विषमं वा ज्वरं कुर्याद् बलव्यापदमेव च ॥ १२० ॥ तस्मान्निर्हरणं कार्यं दोषाणां वमनादिभिः । प्राक्कर्म वमनञ्चास्य कार्यमास्थापनं तथा ॥ १२१ ॥ विरेचनं तथा कुर्याच्छिरसश्च विरेचनम् । क्रमशो बलिने देयं वमनं श्लैष्मिके ज्वरे ॥ १२२ ॥ पित्तप्राये विरेकस्तु कार्य: प्रशिथिलाशये । सरुजेऽनिलजे कार्यं सोदावर्ते निरूहणम् । कटीपृष्ठग्रहार्तस्य दीप्ताग्नेरनुवासनम् ॥ १२३ ॥ शिरोगौरवशूलघ्नमिन्द्रियप्रतिबोधनम् कफाभिपन्ने शिरसि कार्यं मूर्धविरेचनम् ॥ १२४ ॥

Preliminary Treatment – A suitable purgative should be administered even in a case of acute fever if the digested Malas (faecal matter etc.) are accumulated in the internal passages of the Kostha (abdomen), in as much as their presence in the organism in that undigested state may usher in an attack of Visama Jwara attended by distressing symptoms, or may produce loss of strength. Hence they should be eliminated from the system with the half of emetics etc. Emetics, asthapana-enemas, purgatives, Siro-virecana and errhines should be successfully employed for the purpose. Emetics should be at the outset used in case of Kaphaja fever where the patient would be found to be a person of considerable physical strength, and pargatives should be given in a case of fever marked by the predominant action of the deranged Pitta in the event of there being laxity of the bowels (intestines). Niruha-Basti should be applied in a case of Vataja fever attended with aching pain in the limbs and with Udavarta (obstinate constipation of the bowels), whereas Anuvasana-basti should be prescribed for a patient, if there be pain in the regions of the back and the waist. Siro virecana (head-purgative) should be administered in cases marked by the accumulation of the deranged Kapha in the head, as the pain in the heaviness of the head would be relieved, and the sense-organs roused up thereby to their normal functions. 119-124.

दुर्बलस्य समाध्मातमुदरं सरुजं दिहेत् । दारुहैमवतीकुष्ठ-शताह्वाहिङ्गुसैन्धवैः 1 अम्लपिष्टैः सुखोष्णैश्च पवने तूर्ध्वमागते ॥ १२५ ॥ रुद्धमूत्रपुरीषाय गुदे वर्ति निधापयेत् । पिप्पलीपिप्पलीमूल-यवानीचव्यसाधिताम् । पाययेत यवागूं वा मारुताद्यनुलोमिनीम् ॥ १२६ ॥

A plaster composed of Deve-daru, Vaca, Kustha, Satahva, Hingu and Saindhava pasted together with Kanjika should be applied lukewarm to the abdomen in a case of fever attended with painful tympanitis and if the patient be weak, whereas a medicated plug (Varti) prepared with the above drugs should be applied into the anus in a case marked by the upward coursing of the bodily Vayu attended with suppression of stool and urine, and yavagu prepared with Pippali, roots of Pippali. Yavani and Cavya should be given to the patient as a potion, it being remedial for the deranged bodily Vayu. 125-126.

Administration of Ghrita

शुद्धस्योभयतो यस्य ज्वरः शान्तिं न गच्छति । सशेषदोषरूक्षस्य तस्य तं सर्पिषा जयेत् ॥ १२७ ॥

Administration of Ghrita – The residue of the deranged bodily Dosa having lurked in the system (of a patient) even after the exhibition of proper emetics and purgatives, the fever should be remedied by draughts of medicated calrified butter, if the system of the patient be sufficiently dry (Ruksa) 127.

कृशञ्चैवाल्पदोषञ्च शमनीयैरुपाचरेत् । उपवासैर्बलस्थन्तु ज्वरे सन्तर्पणोत्थिते ॥ १२८ ॥

A weak patient with only a small quantity of the deranged bodily Dosa should be treated with the help of soothing (Samaniya) remedies. Fasting should be the principal cure for all types of fever due to (Santarpana) over-eating etc., provided the patient be found to possess sufficient strength. 128.

Diet in Fever

क्लिन्नां यवागूं मन्दाग्निं तृषार्तं पाययेन्नरम् । तृछर्दिहघर्मार्तं मद्यपं लाजतर्पणम् । सक्षौद्रमम्भसा पश्चाज्जीर्णे यूषरसौदनम् ॥ १२९ ॥ उपवासश्रमकृते क्षीणे वाताधिके ज्वरे | दीप्ताग्निं भोजयेत् प्राज्ञो नरं मांसरसौदनम् ॥ १३० ॥ मुद्द्रयूषौदनश्चापि हितः कफसमुत्थिते । स एव सितया युक्तः शीतः पित्तज्वरे हितः ॥ १३१ ॥ दाडिमामलमुद्गानां यूषश्चानिलपैत्तिके । ह्रस्वमूलकयूषेण भोजयेत् कफवातिके । पटोलनिम्बयूषस्तु पथ्यः पित्तकफात्मके ॥ १३२ ॥

Diet — Diluted barley gruel (Yavagu) should be given to a patient constantly feeling thirsty and with impaired digestion. Powdered parched corn (paddy) mixed with honey and water should be given in copious quantity to a patient suffering from the after-effect of liquor, and afflicted with vormiting, thirst, burning or perspiration and it should be followed, when duly digested, by meals of rice-soup and meatsoup. A diet consisting of boiled rice mixed with meat-soup should be given to a patient suffering from an attack of fever marked by the preponderance of the bodily Vayu, as well as in a mild type¹ of fever due to fasting or over-fatiguing physical labour. The diet in a case of Kaphaja fever should consist of boiled rice and of Mudga pulse. In a case of Pittaja fever is should consist of boiled rice and a soup of Mudga pulse and be taken, when cold, with the admixture of sugar. In a case marked by the concerted action of the deranged Vayu and Pitta, the diet should consist of Mudga soup mixed with (the expressed juice of) Amalaka or Dadima. In a case of Vata-slesma fever the diet should be prescribed to be taken with the soup of tender radish, while in one of Kapha-pitta type it should consist of the soup of the leaves of Nimba and Patola. 129-132.

1. This passage is quoted by Sreekantha Datta in his commentary on Cakra-datta where he does not read & (mild type), and his reading appears to be the better one, it being supported by Caraka as well.

दाहच्छर्दियुतं क्षामं निरन्नं तृष्णयाऽर्दितम् । सिताक्षौद्रयुतं लाज-तर्पणं पाययेत च ॥ १३३ ॥ कफपित्तपरीतस्य ग्रीष्मेऽसृपित्तिनस्तथा । मद्यनित्यस्य न हिता यवागूस्तमुपाचरेत् । यूषैरम्लैरनम्लैर्वा जाङ्गलैर्वा रसैर्हितैः ॥ १३४ ॥

Laja-tarpana powdered parched corn (paddy) mixed with a copious quantity of water and with honey ( and sugar) — should be given, instead of any other diet (e.g. boild rice) to a patient suffering from fever marked by burning sensation, vomiting, thirst and weakness. Yavagu is not beneficial in summer as a diet in a case of Kapha-pittaja fever or in a case of Rakta-pitta (Hemoptysis ? ) or in the case of a habitual drunkard. Such a case should be treated with the soup of any pulse or of the meat of Jangala animal with or without any acid juice. 133-134.

मद्यं पुराणं मन्दाग्नेर्यवान्नोपहितं हितम् । सव्योषं वितरेत् तक्रं कफारोचकपीडिते ॥ १३५ ॥

Prepared barely mixed with any old wine would prove beneficial in cases of (fever accompained by ) a dullness of appetite. Takra (buttermilk or whey) mixed with the powdered Tri-katu should be given in case of disrelish for food due to the action of the deranged kapha.

Milk as a diet in fever

कृशोऽल्पदोषो दीनश्च नरो जीर्णज्वरार्दितः । विबद्धः सृष्टदोषश्च रूक्षः पित्तानिलज्वरी ॥ १३६ ॥

पिपासार्तः सदाहो वा पयसा स सुखी भवेत् । तदेव तरुणे पीतं विषवद्धन्ति मानवम् ॥ १३७ ॥

Milk as a diet – Milk may be given with advantage in a case of chronic or lingering fever marked by the scanty presence of the deranged bodily Dosa in the system, by emaciation of the frame and by mental depression as well as a case of Vata-pittaja fever accompained by dryness of the organism and non-emission or otherwise of the deranged bodily Dosas as well as in a case of fever marked by thirst or burning sensation. But milk taken in a case of fever in its acute stage is highly injurious and kills the patient like poison. 136-137.

सर्वज्वरेषु सुलघु मात्रावद् भोजनं हितम् । वेगापायेऽन्यथा तद्धि ज्वरवेगाभिवर्धनम् ॥ १३८ । ज्वरितो हितमश्रीयाद् यद्यप्यस्यारुचिर्भवेत् । अन्नकाले ह्यभुञ्जानः क्षीयते म्रियतेऽथवा ॥ १३९ ॥ सक्षीणः कृच्छ्रतां याति यात्यसाध्यत्वमेव च । तस्माद्रक्षेद् बलं पुंसां बले सति हि जीवितम् ॥ १४० ॥ गुर्व्यभिष्यन्द्यकाले च ज्वरी नाद्यात् कथञ्चन । न तु तस्याहितं भुक्तमायुषे वा सुखाय वा ॥ १४१ ॥

A spare and light diet for a weak person should be observed in all cases of fever, when its intensity abates, as, otherwise by a heavy diet, it is aggravated. A proper and wholesome diet should be given in a case of fever even if the patient would show a positive aversion to it since the want of food at the proper time or when the system craves for it, is sure to be followed by the waste of the body, and may bring about death in end. A food which is heavy of digestion (Guru), or secreting (Kapha-producing) in its effect should by no means be taken nor should food be taken at an improper time, since such a food which is not beneficial, is neither conducive to longevity nor to happiness (in a case of fever). 138-141..

सन्ततं विषमं वाऽपि क्षीणस्य सुचिरोत्थितम् । ज्वरं सम्भोजनैः पथ्यैर्लघुभिः समुपाचरेत् ॥ १४२ ॥

मुद्रान् मसूरांश्चणकान् कुलत्थान समकुष्ठकान् । आहारकाले यूषार्थं ज्वरिताय प्रदापयेत् ॥ १४३ ॥

पटोलपत्रं वार्ताकं कठिल्लं पापचैलिकम् । कर्कोटकं पर्पटकं गोजिह्वां बालमूलकम् ।

पत्रं गुडूच्याः शाकार्थे ज्वरितानां प्रदापयेत् ॥ १४४ ॥

A light diet (such as milk or essence of meat) may be given in copious quantity and with advantage to a patient emaciated through a long and protracted attack of Santata or Visama fever. The soup of such pulses as Mudga, Masura, Canaka (Gram ), Kulattha and Kakustaka etc. may be given with benefit as diet to the hungry patient suffering from fever.

Green leaves of Patola, Vartaka, Kathilla, Papachailika, Karkotaka, Parpataka, Gojiwha, Balmulaka and Guduci should be given to the fever petient as vegetable. 142-144.

Meat diet in Fever

लावान् कपिञ्जलानेणान् पृषताञ्छरभाञ्छशान् । कालपुच्छान् कुरङ्गांश्च तथैव मृगमातृकान् ॥ १४५ ॥ मांसार्थे मांससात्म्यानां ज्वरितानां प्रदापयेत् । सारसक्रौञ्चशिखिनः कुक्कुटांस्तित्तिरांस्तथा । गुरूष्णत्वान्न शंसन्ति ज्वरे केचिच्चिकित्सकाः ॥ १४६ ॥ ज्वरितानां प्रकोपन्तु यदा याति समीरणः । तदैतेऽपि हि शस्यन्ते मात्राकालोपपादिताः ॥ १४७ ॥

Meat-diet— The meat of Lava, kapinjala, Ena, Prsata Sarabha, Kala-puccha, Kuranga, Mrga-matrka (defferent kinds of deer) or sasa (hare) may be prescribed as diet for a fever-patient accustomed to the use of animal food’. Several authorities, however 2, do not recommend the use of the meat of Sarasa, Krounca, Mayura (peacock ). Kukkuta (cock) and of Tittira in case of fever, owing to its heaviness (as regards digestion), as well as to its heat-making potency. (We, too, subscribe to this opinion with a certain limitation). The use of the flesh of these animals may, however, be recommended in a case of fever in moderate quantitiy and at proper time provided the fever is marked by a preponderance of the deranged bodily Vayu. 145-147.

1. According to Caraka, the meat-soup, in cases of fever, may be given with or without the addition of an acid, juice (e.g. Dadima, Amalaki, etc.). 2. Caraku also bolds the same opinion as Susruta.

Prohibitions in fever

परिषेकावगाहांश्च स्नेहान् संशोधनानि च । (स्नानाभ्यङ्गदिवास्वप्न-शीतव्यायामयोषितः ।) कषायगुरुरूक्षाणि क्रोधादीनि तथैव च ॥ १४८ सारवन्ति च भोज्यानि वर्जयेत् तरुणज्वरी । तथैव नवधान्यादिं वर्जयेच्च समासतः ॥ १४९ ।।

Prohibitions in fever – A newly origined fever-patient should forego baths, washing (Pariseka), plunge-bath ( Avagaha. D. R. Pradeha-plaster), anointments, emulsive potions, day-sleep, physical exercise, sexual intercourse and any cold articles or any emetic or purgative medicine (for a time even after his recovery) till he is restored to his wonted strength and vigour.’ 148-149.

अनवस्थितदोषाग्नेरेभिः सन्धुक्षितो ज्वरः । गम्भीरतीक्ष्णवेगत्वं यात्यसाध्यत्वमेव च ॥ १५० ॥ शीततोयदिवास्वप्न- क्रोधव्यायामयोषितः । न सेवेत ज्वरोत्सृष्टो यावन्न बलवान् भवेत् ॥ १५१ ॥ मुक्तस्यापि ज्वरेणाशु दुर्बलस्याहितैर्ज्वरः । प्रत्यापन्नो दहेद् देहं शुष्कं वृक्षमिवानलः ॥ १५२ ॥ तस्मात् कार्य: परीहारो ज्वरमुक्तैर्विरिक्तवत् । यावन्न प्रकृतिस्थ: स्याद् दोषतः प्राणतस्तथा ॥ १५३ ॥

Since the bedily Dosas and digestive fire (Jatharagni) of the patient suffering from fever are unstable hance if the preceeding etiology has not been avoided then the fever gets excited end becomes incuriable having been deeply seated and of acute virulence. The patient who has been convalacing from fever should avoid cold water, day sleep, anger, excercise and saxual intercourse so long he does not regain his strength.

Any of preceding prejudicial acts done in a weak state of health, closely following a recovery from fever may bring on a relapse which invariable consumes the body just as fire does a dried and sapless tree. These rules, therefore, should be strictly followed after recovery from fever till the fundamental Principles of the body have returned to their normal condition and the health and strength is fully regained. 150-153.

1. Additional Text — a patient suffering from acute fever should forego also the use of astringent, heavy and dry food as well as fatty and secreting food. In short he should also discourage mental emotions of anger, grief, etc. as well as the use of newly collected corns. This is evident by Dalhana’s reading.

ज्वरे प्रमोहो भवति स्वल्पैरप्यवचेष्टितैः । निषण्णं भोजयेत् तस्मान्मूत्रोच्चारौ च कारयेत् ॥ १५४ ॥ अरोचके गात्रसादे वैवर्ण्यऽङ्गमलादिषु । शान्तज्वरोऽपि शोध्यः स्यादनुबन्धभयान्नरः ॥ १५५ ॥ न जातु स्नापयेत् प्राज्ञः सहसा ज्वरकर्शितम् । तेन सन्दूषितो ह्यस्य पुनरेव भवेज्ज्वरः ॥ १५६ ॥

A very small amount of physical exertion, in cases of fever, is likely to usher in an attack of fainting fit and hence the patient in such cases should be supported when he sits taking his food or passing urine or stool. An emetic or purgative (Sodhana) remedy should be resorted to even after continuance of a residue of the deranged Dosas in the organism would apprehended from such symptoms as aversion to food, weariness of the limbs, discoloration of the body, its evacuations, etc. A fever-patient emaciated through prolonged suffering should not be largely fed at a time (D. R. should not have a bath) and in haste i.e. until the patient recruits his strength in as much as it might lead to a fresh attack of the disease. 154-156.

चिकित्सेच्च ज्वरान् सर्वान् निमित्तानां विपर्ययैः । श्रमक्षयाभिघातोत्थे स्त्रीणामपप्रजातानां स्तन्यावतरणे मूलव्याधिमुपाचरेत् ॥ १५७ ॥ च यः । तत्र संशमनं कुर्याद् यथादोषं विधानवित् ॥ १५८ ।। अतः संशमनीयानि कषायाणि निबोध मे। सर्वज्वरेषु देयानि यानि वैद्येन जानता ॥ १५९ ॥

All cases of fever should be remedied with therapeutic agents antidotal to the exciting factors. The principal pathogenic cause or causes should be first rernoved and remedied in a case of fever due to bodily exhaustion, waste or hurt. An attack of ( purperal) fever incidental to miscarriage or to the spontaneous accumulation of milk in the breast of the mother after delivery, should be medically treated by an experienced physician with Dosa-subduing (Samsamana) remedies according to the deranged bodily Dosa involved there in. Now we shall deal with the recipes of Dosa-subduing (Samsamana) decoctions which may be advantageously employed in all types of fever. 157-159.

Samsamana decoctions for Vata Jwara

पिप्पलीसारिवाद्राक्षा शतपुष्पाहरेणुभिः । । कृतः कषाय: सगुडो हन्याच्छ्रसनजं ज्वरम् ॥ १६० ॥ शृतं शीतकषायं वा गुडूच्याः पेयमेव तु ॥ १६१ ॥ बलादर्भश्वदंष्ट्राणां कषायं पादशेषितम् । शर्कराघृतसंयुक्तं पिबेद् वातज्वरापहम् ॥ १६२॥ शतपुष्पायचाकुष्ठ- देवदारुहरेणुकाः कुस्तुम्बुरूणि नलदं मुस्तञ्चैवाप्सु साधयेत् । क्षौद्रेण सितया चापि युक्तः क्वाथोऽनिलात्मके ॥ १६३ ॥ द्राक्षागुडूचीकाश्मर्य-त्रायमाणाः ससारिवाः । निःक्वाथ्य सगुडं क्वाथं पिबेद् वातकृते ज्वरे ॥ १६४ ॥ गुडूच्या स्वरसो ग्राह्यः शतावर्याश्च तत्समः । निहन्यात् सगुडः पीतः सद्योऽनिलकृतं ज्वरम् ॥ १६५ ॥ घृताभ्यङ्गस्वेदलेपानवस्थासु च योजयेत् ॥ १६६ ॥

Samsamana decoctions for Vata Jwara – A decocton of Pippali, Sariva, Draksa, Satapuspa and Harenu should with the admixture of treacle in a case of Vataja fever or a of Guduci should be taken by the patient. Similarly a Bala, Darbha and Swa-danstra boiled down to a quarter part duly prepared be given cold infusion decoction of of the original quantity of water and mixed with sugar and clarifed butter; or a decoction of Satapuspa, Vaca, Kustha, Devadaru, Harenuka, Kustumbura, Nalada and Musta mixed with sugar and honey should be given to a patient in a case of Vataja fever. A decoction of Draksa, Guduci, Kasmarya, Trayamana and Sariva mixed with treacle should be prescribed in a case of Vataja fever. A potion of the expressed juice of Guduci mixed with an equal quantity of that of Satavari and with an equal quantity of that of Satavari and with treacle proves almost instantaneously efficacious in a case of fever of the same type. Rubbing of the body with clarified butter as well as fomentation (Sveda) and plaster should also be prescribed under certain conditions in the present disease. 160-166.

1. According to Dalhana the cold infusion of Guduci should be given in a case of Vataja fever involving the action of vitiated Pitta also; whereas the decoction duly prepared of Guduci should be prescribed if, in a case of Vataja-fever, the vitiated Kapha is also involved. Gold infusion is prepared by keeping over-night a quantity of the durgs immersed in hot water. The infusion thus prepared is used in the morning.

Samsamana decoctions for Pittaja Jwara

श्रीपर्णीचन्दनोशीर – परूषकमधूकजः 1 शर्करामधुरो हन्ति कषाय: पैत्तिकं ज्वरम् ॥ १६७॥ पीतं पित्तज्वरं हन्यात् सारिवाद्यं सशर्करम् । सयष्टीमधुकं हन्यात् तथैवोत्पलपूर्वकम् । शृतं शीतकषायं वा सोत्पलं शर्करायुतम् ॥ १६८ ॥ गुडूचीपद्मरोध्राणां सारिवोत्पलयोस्तथा । शर्करामधुरः क्वाथ: शीतः पित्तज्वरापहः ॥ १६९॥

Samsamana decoctions for Pittaja Jwara – A decoction of Sriparni, red sandal wood, Usira, Parusaka and Madhuka (Moul) flowers duly boiled and mixed with a proportionate quantity of sugar (when cold), or a decoction of the durgs of the Sarivadi group duly mixed with sugar, or a decoction of the drugs of the Utpaladi group and Yasti-madhu¹, or a cold infusion of the drugs of the same group mixed with sugar would cure a case of Pittaja fever. A similar preparation of Guduci, Padmaka, Rodhra, Sariva and Utpala taken, when cold, with sugar would prove beneficial in cases of Pittaja fever. 167-169.

द्राक्षारग्वधयोश्चापि काश्मर्यस्याथवा पुनः । स्वादुतिक्तकषायाणां कषायैः शर्करायुतैः । सुशीतैः शमयेत् तृष्णां प्रवृद्धां दाहमेव च ॥ १७० ॥

1. Yasti-madhu is included in the drugs of the Utpaladi group Hence in preparation of this decoction, two parts of Yasti-madhu, should be taken.

शीतं मधुयुतं तोयमाकण्ठाद् वा पिपासितम् । वामयेत् पाययित्वा तु तेन तृष्णा प्रशाम्यति ।। १७१ ॥ क्षीरैः क्षीरिकषायैश्च सुशीतैश्चन्दनैर्युतैः । अन्तर्दाहे विधातव्यमेतैश्चान्यैश्च शीतलैः ॥ १७२ ॥

A decoction of Draksa and Aragvadha, or of Kasmarya or of the drugs of sweet, bitter or astringent gorups mixed with sugar and used, when cold, would alleviate thirst and the severe burning sensation of the body (in case of Pittaja fever). The contents of the stomach should be vomited out by large draughts of cold water saturated with honey whereby thirst (in a case of Pittaja fever) would be alleviated. Milk duly cooked with the decoction (of barks or twigs) of the KsiriVrksa (milk-exuding trees), or with Candana or with any other cooling drugs should be used cold (both internally and externally) as a relief for an internal sensation of burning in a case of Pittaja fever. 170-172.

पद्मकं मधुकं द्राक्षां पुण्डरीकमथोत्पलम् । यवान् भृष्टानुशीराणि समङ्गां काश्मरीफलम् ॥ १७३ ॥ निदध्यादप्सु चालोड्य निशापर्युषितं ततः । क्षौद्रेण युक्तं पिबतो ज्वरदाहौ प्रशाम्यतः | जिह्वातालुगलक्लोम-शोषे मूर्ध्नि च दापयेत् ॥ १७४॥ मातुलुङ्गस्य मधुसैन्धवसंयुतम् । मधुसैन्धवसंयुतम् । केशरं मातुलुङ्गस्य शर्करादाडिमाभ्यां वा द्राक्षाखर्जूरयोस्तथा । वैरस्ये धारयेत् कल्कं गण्डूषञ्च तथा हितम् ॥ १७५ ॥

Draughts of water with Padmaka, Yasti-madhu, Draksa, Paundarika (white lily ), Utpala parched bariey, Usira, Samanga and Kasmari fruit steeped there in and stirred and kept overnight and then mixed and taken with honey (in the morning) would give relief from fever and burning sensation and a plaster of the same drugs should be applied over the scalp in a case of fever accompained by dryness of the tongue, the palate, the throat and of the Kloma. Pastes of the polens or filaments (Kesara) of Matulunga mixed with honey and Saindhava salt,or of Dadima mixed with sugar, Draksa and Kharjura (date) as well as gargles prepared from these drugs should be retained in the mouth with a view to removing its bad taste. 173-175.

Samsamana decoctions for Kaphaja Jwara

सप्तच्छदं गुडूचीञ्च निम्बं स्फूर्जकमेव च। क्वाथयित्वा पिबेत् क्वाथं सक्षौद्रं कफजे ज्वरे ॥ १७६ ॥ कटुत्रिकं नागपुष्पं हरिद्रा कटुरोहिणी । कौटजञ्च फलं हन्यात् सेव्यमानं कफज्वरम् ॥ १७७॥ हरिद्रां चित्रकं निम्बमुशीरातिविषे वचाम् । कुष्ठमिन्द्रयवान् मूर्वां पटोलञ्चापि साधितम् । पिबेन्मरिचसंयुक्तं सक्षौद्रं कफजे ज्वरे ॥ १७८ ।। सारिवातिविषाकुष्ठ-पुराख्यैः सदुरालभैः । मुस्तेन च कृतः क्वाथः पीतो हन्यात् कफज्वरम् ॥ १७९ ॥ मुस्तं वृक्षकबीजानि त्रिफला कटुरोहिणी । परूषकाणि च क्वाथ: कफज्वरविनाशनः ॥ १८० ॥

Samsamana decoctions for Kaphaja Jwara – A decoction of Saptacchada, Guduci, Nimba and Sphurjaka mixed with honey, or of Trikatu, Naga-kesara, Haridra, Katurohini and Indrayava, or of Citraka, Haridra, Nimba, Usira, Ativisa, Vaca, Kustha, Indra-yava, Murva, and Patola mixed with honey and pulverised Marica (black pepper) should be given in a case of Kaphaja fever. A decoction of Sariva, Ativisa, Kustha, Pura (Guggulu), Duralabha and Musta or of Musta, Vrksaka-seeds (indra-yava). Triphala, Katurohni and Parusaka will be found to be equally efficacious in the case of Kaphaja fever. 176-180.

Treatment of Kapha – Vataja Jwara

राजवृक्षादिवर्गस्य कषायो मधुसंयुतः । कफवातज्वरं हन्याच्छीघ्रं कालेऽवचारितः ॥ १८१ ॥ नागरं धान्यकं भार्गीमभयां सुरदारु च। वचां पर्पटकं मुस्तं भूतीकमथ कट्फलम् ॥ १८२ ॥ निष्काथ्य कफवातोत्थे क्षौद्रहिङ्गसमन्वितम् । पातव्यं श्वासकासघ्नं श्लेष्मोत्सेके गलग्रहे। हिक्कासु कण्ठश्वयथौ शूले हृदयपार्श्वजे ॥ १८३ ॥

Treatment of Kapha-Vataja Jwara- A decoction of the component members of the Raja vrksadi group mixed with honey and taken in due course, would readily prove curative in a case of fever due to the concerted action of Vata and Kapha. The administration of the decoction of Nagara, Dhanyaka, Bhargi, Abhaya, Devadaru, Vaca, Parpataka, Musta, Bhutika and Katphala mixed with honey and Hingu (asfoetida) would be attended by almost instantaneous benefit in the present type of fever accompanied with bronchitis, cough, asthma, constriction of the throat, hic-cough, swelling in the throat and aching pain at the chest and at the sides. 181-183.

Pitta-Sleshmaja Jwara

बला ( एला पटोलत्रिफला-यष्ट्याह्वानां वृषस्य च । क्वाथो मधुयुतः पीतो हन्ति पित्तकफज्वरम् ॥ १८४ ॥ कटुकाविजयाद्राक्षा-मुस्तपर्पटकैः कषायो नाशयेत् पीतः श्लेष्मपित्तभवं कृतः । ज्वरम् ॥ १८५ ॥ भार्गीवचापर्पटक-धान्यहिङ्ग्वभयाघनैः काश्मर्यनागरैः क्वाथ: सक्षौद्रः श्लेष्मपित्तजे ॥ १८६ ॥ सशर्करामक्षमात्रां कटुकामुष्णवारिणा । ज्वरं जयेज्जन्तुः कफपित्तसमुद्भवम् ॥ १८७ ॥

Pitta-Sleshmaja Jwara – A decoction duly prepared with Ela, Patola, Tri-phala, Yastyahava and Vrsa ( vasaka) and mixed with honey, or one of Katuka, Vijaya (Haritaki), Draksa, Musta and Parpataka or of Bhargi, Vaca, Parpataka, Dhanyaka, Hingu, Abhaya, Ghana, Nagara and Kasmarya mixed with honey would prove efficacious in a case of fever due to the combined action of the deranged Pitta and Slesma. Similarly two Tola-measure of powdered Katuka and sugar dissolved in warm water proves curative equally in a case of the present type. 184-187.

किराततिक्तममृतां द्राक्षामामलकं शठीम् । निःक्वाथ्य वातपित्तोत्थे तं क्वाथं सगुडं पिबेत् ॥ १८८ ।। रास्त्रा वृषोऽथ त्रिफला राजवृक्षफलैः सह । कषायः साधितः पीतो वातपित्तज्वरं जयेत् ॥ १८९ ॥ , Draksa, Amalaki and Sathi

A decoction of Bhu-nimba, Guduchi mixed with treacle, or of Rasma, Vrsa, (Vasaka), Tri-phala and fruits of Raja-vrksa proves curative in a case of fever due to the combined action of the deranged Vayu and Pitta. 188-189.

तु सर्वदोषसमुत्थे संसृष्टानवचारयेत् । यथादोषोच्छ्रयञ्चापि ज्वरान् सर्वानुपाचरेत् ॥ १९० ॥ वृश्चीर (व) विल्ववर्षाभ्वः पयश्चोदकमेव च । पचेत् क्षीरावशिष्टन्तु तद्धि सर्वज्वरापहम् ॥ १९१ ॥ उदकांशास्त्रयः क्षीरं शिंशपासारसंयुतम् । तत् क्षीरशेषं क्वथितं पेयं नलवेतसयोर्मूले मूर्वायां सर्वज्वरापहम् ॥ १९२ ॥ देवदारुणि । कषायं विधिवत् कृत्वा पेयमेतज्ज्वरापहम् ।। १९३ ।। ( हरिद्रा भद्रमुस्तञ्च त्रिफला कटुरोहिणी | पिचुमन्दः पटोली च देवदारु निदिग्धिका ॥ १९४ ॥ एषां कषायः पीतस्तु सन्निपातज्वरं जयेत् । अविपक्तिं प्रसेकञ्च शोफं कासमरोचकम् ॥ ) त्रैफलो वा ससर्पिष्कः क्वाथः पेयस्त्रिदोषजे ॥ १९५ ॥

Drugs and therapeutic agents remedial to each of the specific deranged Dosas invloved in a case of the Tri-dosaja type should be employed in combination for cure according to the predominance of each Dosa. A potion of milk duly boiled with Vrscira (white Punarnava), Varsabhu (red Punarnava), Bilva and water, but from which the water has entirely evaporated would prove curative in Tridosaja fever. The pith and marrow of a Sirisa tree duly mixed with milk (weighing eight times that of the drug) and with water weighing three times that of the milk, should be boiled down to the quantity of the milk which, if administered as a drink would prove curative in Tridosaja fever. A potion of the decoction’ duly prepared with the roots of Nala and of Vetasa (cane) and Murva and Devadaru would prove remedial to this form of fever2. Clarified butter mixed with the decoction of Tri-phala should be given to a patient suffering from an attack of Tri-dosaja fever.1 190-195.

1. The decoction should be prepared with water only or with milk and water according to the rules of Ksira-paka, as the exigencies of the case required— Dalhana. 2. Additional Text – A potion of the decoction of Haridra, Bhadra-mista, Triphala, Katuka, Nimba, Patola, Devadaru and Kantakari would cure a case of Tridosaja fever with indigestion, water-brash, drospy, cough and disrelish for food.

अनन्तां बालकं मुस्तां नागरं कटुरोहिणीम् । सुखाम्बुना प्रागुदयात् पाययेताक्षसम्मितम् । एष सर्वज्वरान् हन्ति दीपयत्याशु चानलम् ॥ १९६ ॥ द्रव्याणि दीपनीयानि तथा वैरेचनानि च। एकशो वा द्विशो वापि ज्वरघ्नानि प्रयोजयेत् ॥ १९७ ॥ सर्पिर्मध्वभयातैल-लेहोऽयं सर्वजं ज्वरम् । शान्तिं नयेत् त्रिवृच्चापि सक्षौद्रा प्रबलं ज्वरम् ।। १९८ ।।

Two-Tola-measue of powdered Ananta (Duralabha) Valaka, Musta, Sunthi and Katuka should be given with (one Pala of) tepid water with benefit to a patient before sun-rise in Tri-dosaja fever. Moreover, it acts as a good appetiser. Any one or two of the (groups of the) drugs of the purgative or appetising properties can be employed with benefit in a case of (chronic) fever. A lambative composed of Abhaya pasted together with honey and mixed with oil and clarified butter should be licked by the patient in a case of Tri-dosaja fever. Trivrt with honey would pacify a case of high fever. 196-198.

Medical treatment of Vishama Jwara

ज्वरे तु विषमे कार्यमूर्ध्वञ्चाधश्च शोधनम् । घृतं प्लीहोदरोक्तं वा निहन्याद् विषमज्वरम् ॥ १९९ ॥ गुडप्रगाढां त्रिफलां पिबेद् वा विषमार्दितः । गुडूचीनिम्बधात्रीणां कषायं वा समाक्षिकम् । प्रातः प्रातः ससर्पिष्कं रसोनमुपयोजयेत् ॥ २०० ॥ त्रिचतुर्भिः पिबेत् क्वाथं पञ्चभिर्वा समन्वितैः । मधुकस्य पटोलस्य रोहिण्या मुस्तकस्य च । हरीतक्याश्च सर्वोऽयं त्रिविधो योग इष्यते ॥ २०१ ॥

Medical treatment of Vishama-Jwara-Purgatives and emetics should be exhibited in a case of Visama Jwara and the medicated clarified butter described under the treatment of Plihodara (chapter XIV Chikitsa-sthana), or pulverised Tri-phala with the adddition of treacle may be advantageously used in the type under discussion. A decoction of Guduci, Nimba¹ and Dhatri duly mixed with honey, may be likewise prescribed (in a case of Caturthaka ( fever ). The patient should be likewise made to take Lasuna (garlic) with clarified butter. the three decoctions duly prepared with three, four or all the following drugs, viz :- Madhuka, Patola, Katuka, Mustaka (D.R. Batsaka) and Haritaki should be like wise administered. 199-201.

1. Dalhana includes this line also in the additional text. 2. According to Dalhana the decoction of Tri-phala should be used.

सर्पिः क्षीरसिताक्षौद्र- मागधीर्वा यथाबलम् । दशमूलीकषायेण मागधीर्वा प्रयोजयेत् ॥ २०२ ॥ पिप्पलीवर्धमानं वा पिबेत् क्षीररसाशनः । ताम्रचूडस्य मांसेन पिबेद् वा मद्यमुत्तमम् ॥ २०३ ॥

A potion consisting of milk, clarified butter, sugar, honey and Pippati should be administered according to the strength of the patient. Similarly Pippali should be taken with the decoction of Dasa-mula. Pippali Vardhamana (see chapter 1 Caraka, Chikitsa – Sthana) should be likewise used by a patient who should then be made to take only milk or meat-soup. The use of good wine with the meat of cock is also recommended. 202-203.

कोलाग्निमन्थत्रिफला – क्वाथे दना घृतं पचेत् । तिल्वकावापमेतद्धि पिप्पल्यतिविषाद्राक्षा – सारिवाबिल्वचन्दनैः । विषमज्वरनाशनम् ॥ २०४ ॥ – । २०५ ॥ कटुकेन्द्रयवोशीर सिंहीतामलकीघनैः त्रायमाणास्थिराधात्री विश्वभेषजचित्रकैः । पक्कमेतैर्घृतं पीतं विजित्य विषमाग्निताम् ॥ २०६ ॥ जीर्णज्वरशिरःशूल-गुल्मोदरहलीमकान् । क्षयकासं ससन्तापं पार्श्वशूलानपास्यति ॥ २०७ ॥

Use of medicated Ghrita in cases of Visama Jwara-Clarified duly cooked with the decoction of Kola,² Agnimantha Triphala, with milk-curd (Dadhi), with Tilvaka as Kalka would found to be highly efficacious in case of Visama Jwara. A potion of clarified butter duly cooked with the Kalka (and decoction – Dalhana) of Pippali, Ativisa, Draksa, Sariva, Bilva, Candana (red), Katuka, Indra-yava, Usira, Simhi, Tamalaki, Musta, Trayamana, Sthira (Salaparni), Amalaki, Sunthi and Citraka would be found highly beneficial to irregular (Visama) appetite and would cure cases of chronic fever, headache, Gulma, Udara (ascites), Halimaka, consumption, cough, burning sensation in the body and pain at the sides. 204-207.

1. Cakradatta reads “Musta” in place of “Nimba.’ 2. Kola is here used for Panca-kola-viz:- Pippali, Pippali-roots, Cavya, Citraka and Nagara.

Guduchyadi Ghrita

गुडूचीत्रिफलावासा त्रायमाणायवासकैः । क्वथितैर्विधिवत् पक्कमेतैः कल्कीकृतैः समैः ॥ २०८ ॥

द्राक्षामागधिकाम्भोद नागरोत्पलचन्दनैः । पीतं सर्पिः क्षयश्वास-कासजीर्णज्वरान् जयेत् ॥ २०९ ।।

Guduchyadi Ghrita – The use of a medicated clarified butter duly cooked with the decoction of Guduci, Tri-phala, Vasa (D. R. Rasna), Trayamana and Duralabha together with the Kalka of Draksa, Magadhika (Pippali), Ambhoda (Musta), Nagara, Utpala and Candana would be attended by good results in cases of consumption, asthma, cough and Jirna-Jwara (Chronic fever). 208-209.

Kalasyadi Ghrita

कलशीबृहतीद्राक्षा-त्रायन्तीनिम्बगोक्षुरैः । बलापर्पटकाम्भोद-शालपर्णीयवासकैः पक्वमुत्क्कथितैः सर्पिः कल्कैरेभिः समन्वितैः । शटीतामलकीभार्गी-मेदाकतकपौष्करैः ॥२१० ॥ जीर्णज्वरमपोहति । ॥ २११ ॥ क्षीरद्विगुणसंयुक्तं शिरः पार्श्वरुजाकास-क्षयप्रशमनं परम् ॥ २१२ ॥

Kalasyadi Ghrita – Cases of chronic f ever, headache, pain at the sides, cough and of consumption (lit-any wasting disease of the body attended with fever) would readily yield to the curative efficacy of a medicated clarified butter duly cooked and prepared with the decoction of Kalasi, (Prsni-parni), Brhati, Draksa, Trayanti, Nimba, Goksura, Bala, Parpataka, Musta, Sala-parni and Yavasaka and with the Kalka of Sathi, Tamalaki, Bhargi, Meda, Kataka (D.R.—Amalaka) and Puskara-roots and with milk twice as much as the clarified butter. 210-212.

Patoladi Ghrita

पटोलीपर्पटारिष्ट गुडूचीत्रिफलावृषैः । ॥२१३ ॥ । कटुकाम्बुदभूनिम्ब-यासयष्ट्याह्वचन्दनैः ॥२१४ ॥ दार्वीशक्रयवोशीर-त्रायमाणाकणोत्पलैः धात्रीभृङ्गरजोभीरु-काकमाचीरसैघृतम् सिद्धमाश्वपचीकुष्ठ- ज्वरशुक्रार्जुनव्रणान् । हन्यान्नयनवदन- कर्णजान् घ्राणजान् गदान् ॥ २१५ ॥

Patoladi-Ghrita – Clarified butter duly cooked with the Kalka of Patola, Parpata, Arista, ( Nimba), Guduci, Tri-phala, Vrsa, Katuka, Ambuda, (Musta), Bhu- nimba, Yavasa, Yasti -madhu, Candana, Darvi, Indra-yava, Usira, Trayamana, Kana and Utpala and with the expressed juice of Dhatri, Bhrnga-raja, Abhiru (Satavari) and Kakamaci, readily proves curative in cases of Apaci ( scrofula), Kustha, fever, Sukra and Arjuna (two optical diseases), ulcer and in diseases of the mouth, ears, nose and the eyes. 213-215.

Kalyanaka Ghrita

विडङ्गत्रिफलामुस्त मञ्जिष्ठादाडिमोत्पलैः । प्रियङ्ग्वेलैलवालूक – चन्दनामरदारुभिः बर्हिष्ठकुष्ठरजनीपर्णिनीसारिवाद्वयैः हरेणुकात्रिवृद्दन्ती-वचातालीशकेशरैः द्विक्षीरं विपचेत् सर्पिर्मालतीकुसुमैः सह । विषमज्वरश्वासकास-गुल्मोन्मादगरापहम् ॥ २१८ ॥ एतत् कल्याणकं नाम सर्पिर्माङ्गल्यमुत्तमम् । अलक्ष्मीग्रहरक्षोऽग्नि मान्द्यापस्मारपापनुत् ॥ २१९ ॥ शस्यते नष्टशुक्राणां बन्ध्यानां गर्भदं परम् । मेध्यं चक्षुष्यमायुष्यं रेतोमार्गरुजापहम् ॥ २२० ॥ ॥२१६ ॥ ॥ २१७॥

Kalyanaka Ghrita – Clarified butter duly cooked with Kalka of Vidanga, Tri-phala, Musta, Manjistha, Dadima, Utpala, Priyangu, Ela, Elavaluka, Candana, Devadaru, Varhistha, (Valaka), Kustha, Haridra, the two Sariva, Harenuka, Trivrt, Danti, Vaca, Talisa, Kesara and Malati flowers with milk twice as much as clarified butter is called the Kalyanaka Ghrita. The range of its therapeutic application includes such diseases as VisamaJwara, asthma, Gulma, insanity and diseases due to the effect of any poison. It is auspicious and it removes affections due to the evil influences of malignant spirits and demons, etc., dulness of appetite, epileptic fits, senile decay, sterility and diseases of the seminal cord. It invigorates the eye-sight and imparts memory and longevity to the person who uses it. 216-220.

Maha Kalyanaka Ghrita

एतैरेव तथा द्रव्यैः सर्वगन्धैश्च साधितम् | कपिलाया घृतप्रस्थं सुवर्णमणिसंयुतम् ॥ २२१ ॥ तत्क्षीरेण सहकध्यं प्रसाध्य कुसुमैरिमैः । सुमनश्चम्पकाशोक-शिरीषकुसुमैर्घृतम् ॥ २२२ ॥ तथा नलदपद्मानां केशरैर्दाडिमस्य च ॥ २२३ ॥ तिथौ प्रशस्ते नक्षत्रे साधकस्यातुरस्य च । मनुष्यदेवाय ब्राह्मणैरभिमन्त्रितम् ॥ २२४ ॥ कृतं दत्तं सर्वज्वरान् हन्ति महाकल्याणकं घृतम् । दर्शनस्पर्शनाभ्यान्तु सर्वरोगहरं शिवम् ॥ २२५ ॥ अधृष्यः सर्वभूतानां वलीपलितवर्जितः । अस्याभ्यासाद् घृतस्येह जीवेद् वर्षशतत्रयम् ॥ २२६ ॥

Maha-Kalyanaka Ghrita – A prastha measure of clarifed butter made from the milk of a cow of Kapila species and duly cooked with the kalka of the preceding drugs and the drugs known as Sarvagandha (Eladi-gana) and with ( dead) gold and gems should again be duly cooked with the Kalka of Sumanah, Campaka, Asoka and Sirisa flowers and with Nalada and Padma (red lotus) and the polens of Dadima flowers with the milk of a cow of the same species. It should be prepared under the auspicious of favourable astral combinations and lunar planes of both the physician and of the patient and then be duly consecrated by Bramhanas. It is called Maha-kalyanaka Ghrita and may be prescribed for a king. It proves curative in all forms of fever. Its very touch and sight confers bliss and destroys disease. Its use enables a man to live to three hundred years free from disease and decay and to remain invincible against the attacks of all created beings.

Pancha Gavya Ghrita

गव्यं दधि च मूत्रञ्च क्षीरं सर्पिः शकृद्रसः । समभागानि पाच्यानि कल्कांश्चैतान् समावपेत् ॥ २२७॥

त्रिफलां चित्रकं मुस्तं हरिद्रे द्वे विषां वचाम् । विडङ्गं त्र्यूषणं चव्यं सुरदारु तथैव पञ्चगव्यमिदं पानाद् च । विषमज्वरनाशनम्

पञ्चगव्यमिदं पानाद् पाच्यमन्यद् वृषेण च। ॥ २२८ ।।

बलयाऽथ परं पाच्यं गुडूच्या तद्वदेव तु । जीर्णज्वरे च शोफे च पाण्डुरोगे च पूजितम् ॥ २२९ ॥ एतेनैव तु कल्पेन घृतं पञ्चाविकं पचेत् । पञ्चाजं पञ्चमहिषं चतुरुष्ट्रमथापि वा ॥ २३० ॥

Pancha Gavya Ghrita – Equal parts of milk, curd, clarified butter and urine of a cow and the expressed fluid of cow-dung duly cooked with the Kalka of Tri-phala, Citraka, Musta, two kinds of Haridra, Ativisa, Vaca, Vidanga, Tri-katu, Cavya and Suradaru prove curative in Visama Jwara. It is called Panca-Gavya-Ghrita. The same time substances obtained from a cow (e.g. milk, curd, clarified butter, urine and the expressed liquid of cow-dung) may be duly cooked without the addition of any Kalka as also with the above Kalkas and the expressed juice of Vasaka ar of Bala or Guduci.¹ All of these medicated (Ghrrtas are effecacious in cases of Jirna jwara (Chronic fever), chlorosis and edema. The same five substances (e.g.milk, curd, clarified butter, urine and the expressed fluid of dung) of a she-sheep, a she-goat or a she bufflalo and the four substances (e.g. milk curd, clarified butter and urine) of a she-camel may be prepared (and used) in the same manner. 227-230.

Triphaladi Ghrita

॥ २३१ ॥ त्रिफलोशीरसम्पाक-कटुकातिविषान्वितैः । शतावरीसप्तपर्ण-गुडूचीरजनीद्वयैः चित्रकत्रिवृतामूर्वा-पटोलारिष्टवालकैः । किराततिक्तकवचा – विशालापद्मकोत्पलैः ॥ २३२ ॥ । सारिवाद्वययष्ट्याह्य-चविकारक्तचन्दनैः दुरालभापर्पटक-त्रायमाणाटरूषकैः ॥ २३३ ॥

1. Dalhana says that the expressed juice of Vasaka, Bala or Guduci, should be separately used along with the ordinary Kalkas (Tri-phala etc.) of the Panca-gavya Ghrita. But we are inclined to take the lines to mean that Vasaka, Bala and Guduci should be separately used as Kalkas in place of the ordinary Kalkas.

रास्त्राकुङ्कुममञ्जिष्ठा-मागधीनागरैस्तथा । धात्रीफलरसैः सम्यग्द्वगुणैः साधितं हविः ॥ २३४ ॥ परिसर्पज्वरश्वास-गुल्मकुष्ठनिवारणम् । पाण्डुप्लीहाग्निमान्देयभ्य एतदेव परं हितम् ॥ २३५ ॥

Triphaladi Ghrita – Claified butter duly cooked with the Kalkas’ of Tri-phala, Usira, Sampaka, Katuka, Ativisa, Satavari, Saptaparna, Guduci, the two kinds of Rajani, Citraka, Trivrta, Murva, Patola, Arista, Balaka, Kirata- tikta, Vaca, Visala, Padmaka, Utpala, the two kinds of Sariva, Yasti-madhu, Cavika, Rakta-candana, Duralabha, Parpataka, Trayamana, Atarusaka (Vasaka), Rasna, Kumkuma (Saffron), Manjistha, Magadhi and Nagara with the expressed juice of Dhatri weighing twice as much as clarified butter proves curative in Parisarpa ( erysipelas), fever, Asthma, Gulma, Kustha, Chlorosis, enlargement of the spleen and dulness of appetite. 231-235.

Patoladi Ghrita

पटोलकटुकादार्वी-निम्बवासाफलत्रिकम् । दुरालभापर्पटक-त्रायमाणाः पलोन्मिताः ॥ २३६ ॥ प्रस्थमामलकानाञ्च क्वाथयेत् सलिलार्मणे । तेन पादावशेषेण घृतप्रस्थं विपाचयेत् ॥ २३७ ॥ कल्कैः कुटजभूनिम्ब घनयष्ट्याह्नचन्दनैः । सपिप्पलीकैस्तत्सिद्धं चक्षुष्यं शुक्लयोर्हितम् ॥ २३८ ॥ घ्राणकर्णाक्षिवदन-वर्त्मरोगव्रणापहम् ॥ २३९ ॥ रक्तपित्तकफस्वेद क्लेदपूयाङ्गशोषणम् । कामलाज्वरवीसर्प गण्डमालाहरं परम् ॥ २४० ॥

Patoladi Ghrita – One Pala weight each of Patola, Katuka, Darvi, Nimba, Vasa, Tri-phala, Duralabha, Parpataka and Trayamana and a Prastha measure of Amalaka should be boiled in one Drona measure of water down to its quarter measure. A Prastha measure of Ghrita should then be cooked with the above decoctions.2 The Ghrita thus prepared proves curative in cases of Rakta-pitta, diseases due to Kapha, perspiration, muco-purulent discharges, atrophy of the limbs, fever, chlorosis, erysipelas and Ganda-mala (scrofula). 236-240.

1. Some here add ghana (Musta) with the other Kalkas.

2. Additional text — Some recommend the use of Kutaja, Bhunimba, Ghana (Musta), Yasti-madhu, Candana and Pippali add Kalka in the preparation of this Ghrita and this proves efficacious in the diseases of the eye, nose, ear, mouth and of the white part of the eye and of the eye-lid and in ulcer.

शृतं पयः शर्करा च पिप्पल्यो मधुसर्पिषी | पञ्चसारमिदं पेयं मथितं विषमज्वरे । क्षतक्षीणे क्षये श्वासे हृद्रोगे चैतदिष्यते ॥ २४१ ॥

Panca- Sara- Boiled milk, sugar, Pippali, honey and clarified butter should be taken by stirring them together with hands. The compound is called Panca-sara and may be employed with advantage in cases of Visama-Jwara, Ksata-Ksina, consumption, asthma and affections of the heart. 241.

Medicated Oils (Tailas)

लाक्षाविश्वनिशामूर्वा-मञ्जिष्ठास्वर्जिकामयैः । षड्गुणेन च तक्रेण सिद्धं तैलं ज्वरान्तकृत् ॥ २४२ ॥ क्षीरिवृक्षासनारिष्ट – जम्बूसप्तच्छदार्जुनैः शिरीषखदिरास्फोटामृतवल्ल्याटरूषकैः । ।। २४३ ।। कटुकापर्पटोशीर-वचातेजोवतीघनैः । साधितं तैलमभ्यङ्गादाशु जीर्णज्वरापहम् ॥ २४४ ॥

Medicated Oils (Tailas)— A medicated oil duly prepared by cooking it with Laksa, Visva, Nisa, Murva, Manjistha, Swarjika and Amaya (Kustha) as Kalka and with Takra weighing six times as much as oil acts as a febrifuge. A medicated oil duly cooked and prepared with Ksiri-Vrksa, Asana, Arista, Jambu, Sapta-cchada, Arjuna, Sirisa, Khadira, Asphota, Amrta – valli, Atarusaka, Katuka Parpata, Usira, Vaca, Tejovati and Ghana as Kalka may be employed in anointig the body of the patient in a case of Jirna Jwara with benefit. 242-244.

निर्विषैर्भुजगैर्नागैर्विनीतैः कृततस्करः । त्रासयेदागमे चैनं तदहर्भोजयेन्न अत्यभिष्यन्दिगुरुभिर्वामयेद् वा पुनः पुनः । मद्यं तीक्ष्णं पाययेत घृतं वा ज्वरनाशनम् ॥ २४६ ॥ पुराणं वा घृतं काममुदारं वा विरेचनम् । निरूहयेद् वा मतिमान् सुस्विन्नं तदहर्नरम् ॥ २४७॥ च ॥ २४५ ॥

The patient should be frightened with a non-venomous snake, trained elephants and bogus thieves (or rebuked with a thievish act falsely supposed to have been committed by him before) at the appointed date and hour of the paroxysm and be kept in empty stomach for the day. In the alternative, he should be fed with heavy and extremely secreting articles ( milk, milk-curd, etc.) and be made to continually vomit out the contents of his stomach afterwards, or he should be made to drink any strong liquor, or febrifugal medicated clarified butter or simply matured clarified butter in copious quantity or be treated with drastic purgatives, or with! fomentations followed by NirudhaBasti application on the date of the expected attack. 245-247.

Fumigation and Anjana

अजाव्योश्चर्मरोमाणि वचा कुष्ठं पलङ्कषा । निम्बपत्रं मधुयुतं धूपनं तस्य दापयेत् । वैडालं वा शकृद् योज्यं वेपमानस्य धूपनम् ॥ २४८ ॥ पिप्पली सैन्धवं तैलं नेपाली चेक्षणाञ्जनम् । उदरोक्तानि सर्पींषि यान्युक्तानि पुरा मया । कल्पोक्तञ्चाजितं सर्पिः सेव्यमानं ज्वरं जयेत् ॥ २४९ ॥

Fumigation and Anjana – The body of the patient should be fumigated with the fumes of the skin and hairs of a goat and a sheep mixed with Vaca, Kustha, Palankasa (Guggulu), Nimba, Leaves and honey and burnt together. The excreta of a cat should be similarly used in fumigating the body of the patient in a case of fever marked by shivering. Pippali, Saindhava and Naipali (Manah – sila) should be pasted together and mixed with oil and be applied along the eye-lids as an Anjana.

The medicated Ghritas mentioned in conection with the treat of Udara (ascites), as well as the Ajita Ghrita mentioned in the Kalpasthana (Chapter II) may be likewise empolyed with benefit in fever. 248-249.

भूतविद्यासमुद्दिष्टैर्बन्धावेशनपूजनैः 1 जयेद्भूताभिषङ्गोत्थं विज्ञानाद्यैश्च मानसम् ॥ २५० ॥ श्रमक्षयोत्थे भुञ्जीत घृताभ्यक्तो रसौदनम् । अभिशापाभिचारोत्थौ ज्वरौ होमादिना जयेत् ॥ २५१ ॥ दानस्वस्त्ययनातिथ्यैरुत्पातग्रहपीडितम् । अभिघातज्वरे कुर्यात् क्रियामुष्णविवर्जिताम् ॥ २५२ ॥ कषायमधुरां स्त्रिग्धां यथादोषमथापि वा। ओषधीगन्धविषजौ विषपित्तप्रसाधनैः ॥ २५३ ॥ कषायञ्च हितं तत्र सर्वगन्धकृतं तथा । निम्बदारुकषायं वा हितं सौमनसं तथा ॥ २५४ ॥ यवान्नविकृतिः सर्पिर्मद्यञ्च विषमे हितम् । सम्पूजयेद् द्विजान् गाश्च देवमीशानमम्बिकाम् ॥ २५५ ॥

A case of fever due to the malignant influence of the spirits, etc. should be remedied with the help of magical incantations (Avesana), binding and beating (D.R. — adoration) mentioned in the treatment of Bhuta-vidya (demonology ) – Chapters LX-LXII). A case of fever due to any mental condition should be cured with psychic (hypnotic) measures; while the one due to overfatigue or exhaustion should be treated with diets of Rasaudana’ after anointing the body of the patient with clarified butter. Fever due to any curse or to deadly incantations (exorcism) may be cured by performing Homa (offering oblations to the gods) and such other ceremonies; while the cases due to the malignant influence of any hostile planet, or of any unearthly sound may be cured by practising charity, hospitality and peace-giving rites (Svastyayana ). All heat-engendering (Usna) measures are prohibited in a case of traumatic fever and sweet and astringent drugs charged with oil or clarified butter should be prescribed. Other therapeutic agents should also be employed according to the nature of the specific derangement of Dosa involved in the case. In a case of fever caused by the smell of any herb or cereals or in one due to the effect to any sort of poison, the treatment should consist in such measures as would alleviate the poison and the aggravated Pitta in system.² Decoction of Sarvagandha (the drugs of the Eladi-gana ) is also beneficial in these cases.

1. Rasaudana is a kind of food prepared by boiling rice in meat soup (instead of in water). The term may, however, mean rice simply mixed with meat-soup. 2. In place of “विषपित्तप्रसादनैः some read ” विषपौतप्रसादनैः” and that would mean that the measures and remedies prescribed in cases of poisoning (see Kalpa-sthana) should be applied. This variant seems to be the better one.

A decoction of Nimba and Deva-daru or of Jati flowers may be prescribed as well. Clarified butter, wine and preparations of barely grains are wholesome in a case of Visama-Jwara which may be got rid of as well by worshipping Brahmans, cows, the god Isana, and Ambika. 250-255.

कफवातोत्थयोश्चापि ज्वरयोः शीतपीडितम् । दिह्यादुष्णेन वर्गेण परश्चोष्णो विधिर्हितः ॥ २५६ ॥ सिञ्चेत् कोष्णैरारनाल-शुक्तगोमूत्रमस्तुभिः । दिह्यात् पलाशैः पिष्टैर्वा सुरसार्जकशिग्रुजैः ॥ २५७॥ क्षारतैलेन चाभ्यङ्गः सशुक्तेन विधीयते । पानमारग्वधादेश्च क्वथितस्य विशेषतः ॥ २५८ ॥ अवगाह: सुखोष्णश्च वातघ्नक्काथसंयुतः । जित्वा शीतं क्रमैरेभिः सुखोष्णजलसेचितम् ॥ २५९ ॥ प्रवेश्यौर्णिककार्पास-कौशेयाम्बरसंवृतम् । शाययेद् ग्लानदेहञ्च कालागुरुविभूषितम् ॥ २६० ॥

The body of the patient overwhelmed with coldness (shivering) in cases of fever due to the action of the aggravated Kapha or Vayu, should be plastered with a paste of the drugs of the heat-making group.¹ and heating measures should then be resorted to. In the alternative, a compound of aranala, Sukta, cow’s urine and Mastu (curd-cream) made lukewarm should be sprinkled over the body. Plasters of the leaves of Surasa, Arjaka and Sigru pasted together with water would prove beneficial. The body may be rubbed with Ksara-taila (oil cooked with alkali) mixed with Sukta. A decoction of the drugs of the Aragvadhadi group proves highly efficacious particularly in the present case, and decoction of Vayu-subduing drugs should be used tepid as a bath. The shivering having been thus relieved with the foregoing measures and by the sprinkling of tepid water over the body, the languid body of the patient should be smeared with pasted Kalaguru and wrapped up in a silk, woolen or linnen cover and then the patient should be made to lie in a bed. 256-260.

1. Dalhana explains the Usna-varga (heat-making group) to mean the Bhadradarvadi, Surasadi and the Eladi groups.

स्तनाढ्या रूपसम्पन्नाः कुशला नवयौवनाः | भजेयुः प्रमदा गात्रैः शीतदैन्यापहाः शुभाः ॥ २६१ ॥ नीलोत्पलदलेक्षणाः । शरच्छशाङ्कवदना स्फुरितभ्रू लताभङ्ग-ललाटतटकम्पनाः प्रलम्बिविलसत्काञ्च्यो विम्बीफलनिभाधराः । कृशोदर्योऽतिविस्तीर्ण-जघनोद्वहनालसाः कुङ्कुमागुरुदिग्धाङ्ग्यो सुगन्धिधूपित शुक्ष्ण-स्त्रस्तांशुकविभूषणाः गाढमालिङ्गयेयुस्तं ॥ २६२ ॥ घनतुङ्गपयोधराः । ॥ २६३ ॥ ।। २६४ ॥ तरुं वनलता इव । प्रह्लादञ्चास्य विज्ञाय ताः स्त्रीरपनयेत् पुनः ॥ २६५ ॥ तासामङ्गवरश्लेष-निवारितहिमज्वरम् भोजयेद्धितमन्नञ्च यथा सुखमवाप्नुयात् ॥ २६६ ॥

Damsels young, beautiful and skilled in the sport of love, with faces glowing like the full moon of autumn and darting forth beams of love from their languid blue-lotus-like eyes, with eye-brows moving in the ardour of desire and with dreary foreheads throbbing with the gentle pulsations of love, with girdles sliding buttocks naturally making them lazy in their steps, with their lips like the ripe Bimba fruit in their luminous redness, with their emaciated belly, elevated thick breasts, and smeared with saffron and Aguru pastes and clad in thin transparent garment, fumigated and scented with the vapours of burnt Aguru, should be asked to take the patient into a firm embrace like a forest-creeper entwining itself around a sylvan tree, and the girl should be told to keep off as soon as the patient would feel himself heated. The patient thus cured of the disease (cold-fever) by the fond embrace of these beautiful damesels should be treated to such a wholesome repast as would be welcome to him. 261-266.

दाहाभिभूते तु विधिं कुर्याद् दाहविनाशनम् । मधुफाणितयुक्तेन निम्बपत्राम्भसाऽपि वा । दाहज्वरार्तं मतिमान् वामयेत् क्षिप्रमेव च ॥ २६७॥ शतधौतघृताभ्यक्तं दिह्याद् वा यवशक्तुभिः । कोलामलकसंयुक्तैः शुक्तधान्याम्लसंयुतैः ॥ २६८ ॥ अम्लपिष्टैः सुशीतैश्च फेनिलापल्लवैस्तथा । अम्लपिष्टैः सुशीतैर्वा पलाशतरुजैर्दिहेत् ॥ २६९ ॥ बदरीपल्लवोत्थेन फेनेनारिष्टकस्य च। लिप्तेऽङ्गे दाहतृणमूर्च्छाः सर्वथैव प्रशाम्यति ॥ २७० ॥

Measures which alleviate the burning sensation should be employed in a case of fever marked by severe burning sensation of the body. Vomiting should be induced in such cases with honey and treacle mixed with the (cold) infusio of Nimba leaves. The body of the patient should be anointed with Sata-dhauta¹ Ghrita and then plastered with a paste formed by mixing powders of barley, Kola and Amalaka with the fermented boilings of Suka Paddy, or with the cold paste of tender leaves of Phenila (soap-berry) mixed with Kola and Amalaka and pasted with Amla (Kanjika), or with the cold paste with Amla (Kanjika), or with the cold paste of the leaves of Palasa pasted with Amla (Kanjika), or with the froth (produced by stirring in Kanjika the paste) of the leaves of Badara or Arista, whereby thirst, swoon and burning sensation would be relieved and removd. 267-270. 2

यवार्धकुडवं पिष्वा मञ्जिष्ठापलं तथा । अम्लप्रस्थशतोन्मिश्रं तैलप्रस्थं विपाचयेत् ।

एतत् प्रह्लादनं तैलं ज्वरदाहविनाशनम् ॥ २७१ ॥

A Prastha measure of oil duly prepared by cooking it with half a Kudava measure of Yava (barley), half a Pala weight of Manjistha and a hundred Prastha measure of Amla (Kanjika). The oil is called Prahladana (refreshing) Taila and it relieves the burning sensation of the body due to an attack of fever. 271.

न्यग्रोधादिर्गणो यस्तु काकोल्यादिश्च यो गणः । उत्पलादिर्गणो यस्तु पिष्टैर्वा तैः प्रलेपयेत् ॥ २७२ ॥

1. Clarified butter washed hundred times in water is known as Sata-dhauta Ghrita. 2. Arista according to Dalhana and Srikantha (the commentator of Vnda) may mean either Nimba or Phenila (soap-berry). But Sivadasa, the commentator of Cakradatta, explains, Arista to mean (leaves of) Nimba. The practice, however, is, to use the leaves of Nimba.

तत्कषायाम्लसंसिद्धाः स्नेहाश्चाभ्यञ्जने हिताः । तेषां शीतकषाये वा दाहार्तमवगाहयेत् ॥ २७३ ॥ दाहवेगे त्वतिक्रान्ते तस्मादुद्धृत्य मानवम् । परिषिच्याम्बुभिः शीतैः प्रलिम्पेच्चन्दनादिभिः ॥ २७४ ॥ दीनमनसमाविषेयुर्वराङ्गनाः । सानन्दा ॥ २७५॥ पेलवक्षौमसंवीताश्चन्दनार्द्रपयोधराः बिभ्रत्योऽब्जस्त्रजश्चित्रा मणिहारविभूषिताः । भजेयुस्ताः स्तनैः शीतैः स्पृशन्त्यऽम्बुरुहैः सुखः ॥ २७६ ॥ प्रह्लादञ्चास्य विज्ञाय ताः स्त्रीरपनयेत् पुनः । हितञ्च भोजयेदन्नं तथाऽऽप्नोति सुखं महत् ॥ २७७ ॥ पित्तज्वरोक्तं शमनं विरेकोऽन्यद्धितञ्च यत् ॥ २७८ ॥

In the alternative, the body of the patient should be plastered with the pasted drugs of the Nyagrodhadi, Kakolyadi or Utpaladi group, or anointed with a Sneha duly cooked with the decoction of the drugs of the preceding groups and with Amla, or the patient should be given a bath (Avagaha) in the Sita-kasaya’ of these drugs. On the alleviation of the burning sensation, the patient should be raised out of the tub and then washed with the spray of cold water and smeared with soothing sandal pastes, etc. Young, gay, beautiful and lotus-faced damsels with their youthfull cooling breasts profusely smeared with sandal pastes, wearing garlands of beautiful lotus flowers as well as necklace of pearls, etc. and clad in fine silken clothes should be asked to hold the depressed patient in their firm embrace and to kiss him. These damsels should be removed as soon as the patient would exhibit symptoms of exhilaration. He should be given wholesome (Pitta-subduing) food which would give him much relief. Purgative and pacifying (soothing) medicines described in connection with the Pittaja fever are likewise beneficial in the present case. 272-278.

निर्हरेत् पित्तमेवादौ दोषेषु समवायिषु । दुर्निवारतरं तद्धि ज्वरार्तेषु विशेषतः ॥ २७९॥

1, “sita-kasaya” may here mean either the cold infusion of the drugs or only the cold decoction.

General treatment of the Complications

छर्दिमूर्च्छापिपासादीनविरोधाज्वरस्य तु । उपद्रवान् जयेच्चापि प्रत्यनीकेन हेतुना ॥ २८० ॥

General treatment of the Complications – The deranged Pitta should be crushed and remedied first of all in a case of fever, involving therewith the co-operation of any of the deranged Dosas of the body in as much as it is extermely hard to subdue the deranged Pitta especially in a case of fever. Such distressing symptoms as vomiting, epileptic fits, thirst, etc. should be remedied with such therapeutic agents as are not hostile or aggravating to the principla disease (fever) but are antidotal to the exciting factors. 279-280.

विशेषमपञ्चात्र मधुकं रजनीं मुस्तं अञ्जनं तिन्तिडीकञ्च त्वचं व्याघ्रनखञ्चैव मातुलुङ्गरसो दिह्यादेभिर्ज्वरार्तस्य मधुशुक्तयुतैः शृणूपद्रवनाशनम् । दाडिमञ्चाम्लवेतसम् नलदं पत्रमुत्पलम् ॥ २८१ ॥ मधु । शिरः ॥ २८२ ॥ । ज्वरितानामुपद्रवान् ॥ २८३ ॥ मधूलिकाम् । शिरोऽभितापसम्मोह-वमिहिक्काप्रवेपथून् नाशयत्येष प्रदेहो मधूकमथ हीबेरमुत्पलानि लीढ्वा चूर्णानि मधुना सर्पिषा च जयेद् वमिम् । कफप्रसेकासृपित्त-हिक्काश्वासांश्च दारुणान् ॥ २८४ ॥ लिहन् ज्वरार्तस्त्रिफलां पिप्पलीञ्च समाक्षिकाम् । कासे श्वासे च मधुना सर्पिषा च सुखी भवेत् ॥ २८५ ॥ Specific treatment of the complications-Now hear me telling other specific remedies for the complications. A plaster composed Yastimadhu, Rajani, Musta, Dadima, Amla-vetasa, RasanjanaTintidika (Tamarind), Nalada (Mansi), Patra, Utpala Cinnamon), Vyaghra-nakha, the expressed juice of Matulunga, honey Madhu-sukta, 1 if applied to the head, would alleviate heat in head, delirium, vomiting, hic-cough, and shivering –concomitants in cases of fever. Vomiting would yield to the use of a compound consisting of Madhuka flower, Hrvera, Utpala and Madhulika mixed with honey and clarified butter and used to be licked up with the tongue as a lambative. It is equally efficacious in water-brash, hic-cough, Raktapitta (hemoptysis) and asthma. Fits of cough and asthma in cacses of fever readily yield to the use of the electuary prepared with Tri-phala Pippali and Maksika¹ and mixed with honey and clarified butter. 281-285.

1. Madhu-sukta is prepared by preserving th eexpressed juice of Jambira-lemon, pippali and honey in an earthen pot formerly used in keeping honey. It should be laid for a month under the heap of paddy before use. (Dalhana) for an alternative mode of preparation see शार्ङ्गधर, Chapter X — मध्य खण्ड.

विदारी दाडिमं लोधं दधित्थं बीजपूरकम् । एभिः प्रदिह्यान्मूर्धानं तृड्दाहार्तस्य देहिनः ॥ २८६ ॥ दाडिमस्य सितायाश्च द्राक्षामलकयोस्तथा । वैरस्ये धारयेत् कल्कं गण्डूषञ्च यथाहितम् । क्षीरेक्षुरसमाक्षीक-सर्पिस्तैलोष्णवारिभिः ॥ २८७ ॥ शून्ये मूर्ध्नि हितं नस्यं जीवनीयशृतं घृतम् ॥ २८८ ॥

A plaster of Vidari, Dadima, Lodhra, Dadhittha and Bijapuraka pasted together may be applied with advantage to the scalp of a feverpatient afflicted with thirst and burning sensation. Pastes of Dadima and sugar and of Draksa and Amalaka, if kept in the mouth or a gargle (Gandusa) of milk, expressed juice of sugar-cane, Madhvika, 2 clarified butter, oil and warm water, according to the exigency of the case, would remove the bad taste in the mouth in fever. An empty feeling in the head in fever would be relieved by using as an errhine (Nasya) the medicated clarified butter prepared with the drugs of the ya group. 286-288.

चूर्णितैस्त्रिफलाश्यामा-त्रिवृत्पिप्पलिसंयुतैः । सक्षौद्रः शर्करायुक्तो विरेकस्तु प्रशस्यते ॥ २८९ ॥ पक्के पित्तज्वरे रक्ते चोर्ध्वगे वेपथौ तथा । कफवातोत्थयोरेवं स्नेहाभ्यङ्गैर्विशोधयेत् ॥ २९० ॥

1. Dalhana takes “Maksika” in the sense of honey and coments largely on the seperate use of honey (मधु ) in the compound. But we are inclined to take “Maksika” as the mineral of the same name. 2. Dalhana sems to read “Maksika”, and explains it as honey. “Madhvika” which generally means the wine made of honey, may however, also mean honey.

हृतदोषो भ्रमार्तस्तु लिह्यात् क्षौद्रसिताभयाः ॥ २९१ ॥

A pulverised compound consisting of Triphala, Syama, Tivrt and Pippali mixed with honey and sugar, can be given for purgative purpose with benefit after the digestion of the deranged Dosa in a case of chronic Pittaja fever, in an up-coursing Raktapitta and in shivering. The system of the patient should be cleansed with similar purgatives and lardaceous lubrications in cases of Kaphaja and Vataja fever. Lambative of honey, sugar and Abhaya should be given in a case marked by vertigo (Bhrama) even after the subsidence of the aggravated Dosa. 289-291.

Applicatin of Bastis in Jwara

वातघ्नमधुरैर्योज्या निरूहा वातजे ज्वरे । विभज्य दोषं प्राणञ्च यथास्वं चानुवासना: ॥ २९२ ॥ उत्पलादिकषायाद्याश्चन्दनोशीरसंयुताः । शर्करामधुराः शीताः पित्तज्वरहरा मताः ॥ २९३ ॥ आम्रादीनां त्वचं शङ्खं चन्दनामलकोत्पलैः । गैरिकाञ्जनमञ्जिष्ठा- मृणालान्यथ पद्मकम् ॥ २९४ ॥ श्लक्ष्णपिष्टन्तु पयसा शर्करामधुसंयुतम् । सुपूतं शीतलं बस्तिं दह्यमानाय दापयेत् ॥ २९५ ॥ ज्वरदाहापहं तेषु सिद्धञ्चैवानुवासनम् ॥ २९६ आरग्वधगणक्काथाः पिप्पल्यादिसमायुताः । सक्षौद्रा एव देयाः स्युः कफज्वरविनाशनाः ॥ २९७ ॥ कफघ्नैरेव संसिद्धा द्रव्यैश्चाप्यनुवासना ॥ २९८ । संसर्गे सन्निपाते च संसृष्टा बस्तयो हिताः । संसृष्टैरेव संसृष्टा द्रव्यैश्चाप्यनुवासनाः ॥ २९९ ॥

Applicatin of Bastis – Niruha-bastis charged with the decoctions of sweet (Kakolyadi) or Vayu-subduing (Bhadra-darvadi) drugs, should be applied in fever due to the derangement of the bodily Vayu, according to the nature and intensity of the specific deranged Dosa in the case and to the strength of the patient; in the alternative, Anuvasana Basti should also be similarly applied. The decoction of the drugs of the Utpaladi group mixed with Candana and Usira and sweetened with the addition of sugar should be similarly applied cold (as a Niruha Basti) in cases of Pittaja fever. A Basti (in the manner of Niruha) charged with a compound consisting of Amra-barks, etc. Samkha (conch), Candana, Utpala, Gairika, Rasanjana,Manjistha, Mrnala and Padama-kastha pasted together and dissolved in milk saturated with sugar and honey should be passed through a piece of linen and then applied cold in a case of (Pittaja) fever marked by intolerable pain. The characteristic burning sensation due to fever may be relieved by applying Basti charged with a decoctin of the preceding drugs in the manner of an Anuvasana-basti. A Niruha Basti charged with the decoction of the drugs of the Aragvadhadi group mixed with (the powder of) the durgs of the Pippaladi group and with honey should be applied in cases of Kaphaja fever and the decoction of the kaphasubduing (Aragvadhadi) drugs should also be injected into the rectum in the manner of an Anuvasana Basti. In cases of fever due to the aggravation of two or three Dosas, the Bastis (Niruha and Anuvasana) to be applied should be charged with the decoction of the durgs respectively antidotal to the deranged Dosas involved in each case. 292-299.

वातरोगापहाः सर्वे स्नेहा ये सम्यगीरिताः । विना तैलं त एव स्युर्योज्या मारुतजे ज्वरे ॥ ३०० ॥ निखिलेनोपयोज्याश्च त एवाभ्यञ्जनादिषु । पैत्तिके मधुरैस्तिक्तैः सिद्धं सर्पिश्च पूज्यते । श्लैष्मिके कटुतिक्तैश्च संसृष्टानीतरेषु च ॥ ३०१ ॥

All the medicated lardacious substances with the exception of oil, which have been prescribed as being efficacious (in the use of Bastis) in deseases of the deranged Vayu, are equally applicable in (Anuvasana Bastis) in a case of fever due to the same cause. But all of them (including also oil) are equally applicable to anointing etc. Lubrication of the body with oil at the close of the acute stage i.e., on the thirteenth or fourteenth day of the attack would be attended with benefical results in a case of Vata–Slesma fever, where fomentations have utterly failed to relieve the distressing symptoms of the deranged Vayu. Clarified butter duly cooked with sweet and bitter drugs should be used (for the purpose of annointing) in Pittaja fever; while in Kaphaja fever, the Ghrita should be cooked with bitterand pungent drugs. In the cases of fever due to the concerted action of two or three Dosas, the Ghrita should be cooked with the drugs of two or more of the above groups according to the nature of the Dosas involved in each case. 300-301.

हृतावशेषं पित्तन्तु त्वक्स्थं जनयति ज्वरम् । पिबेदिक्षुरसं तत्र शीतं वा शर्करोदकम् ॥ ३०२ ॥ शालिषष्टिकयोरन्नमश्नीयात् क्षीरसंप्लुतम् । कफवातोत्थयोरेव स्वेदाभ्यङ्गौ प्रयोजयेत् ॥ ३०३ ॥ घृतं द्वादशरात्रात् तु देयं सर्वज्वरेषु च | तेनान्तरेणाशयं स्वं गता दोषा भवन्ति हि ॥ ३०४ ॥ धातून् प्रक्षोभयन् दोषो मोक्षकाले बलीयते । तेन व्याकुलचित्तस्तु म्रियमाण इवेहते ॥ ३०५ ॥

The presence of even a small residue of the deranged Pitta in the organism maintains the heat of the skin up to the fever-point, so the remedy consists in taking the expressed juice of sugar-cane, or sweet cordials of Sarbats (Sugar dissolved in water), and the diet in such a case should consist of cooked Sali and Sasti rice and milk. Fomentations and anointments should be employed in cases of Kaphja and Vataja fever. Draughts of clarified butter should be given in all forms of fever at the close of twelve days, for by that time the aggravated Dosas return to their respective Asayas (places in the system). The Dosa involved (in a case of fever) becomes aggravated by affecting, at the time of the remission of the fever, the other fundamental vital principles (Dhatus) of the body and thereby makes the patient weak and dejected at this time. 302-305.

Symptoms of remission of fever

लघुत्वं शिरसः स्वेटो मुखमापाण्डु पाकि च । क्षवथुश्चान्नकाङ्क्षा च ज्वरमुक्तस्य लक्षणम् ॥ ३०६ ॥

Symptoms of remission – The features or indications which mark a complete remission of fever, are lightness of the head, flow of perspiration pale and yellowish colour of the face, sneezing and desire for food. 306.

शम्भुक्रोधोद्भवो घोरो बलवर्णाग्निसादकः । रोगराड्रोगसङ्घातो ज्वर इत्युपदिश्यते ॥ ३०७ ॥

व्यापित्वात् सर्वसंस्पर्शात् कृच्छ्रत्वादन्तसम्भवात् । अन्तको हेयष भूतानां ज्वर इत्युपदिश्यते ॥ ३०८ ॥

Fever originating from the wrath-fire of the god Sambhu, is a dangerous disease. It effects appetite and the strength as well as the complexion of the body and is virtually the sum-total of all the other diseases. It is, therefore called the lord of all bodily diseases. It is common to all created beings (men and animals), affects the whole of th eorganism (including also the mind), is extremely hard to cure and is present in all cases at the time of the death of all creatures. Hence it is rightly called the destroyer of created beings. 307-308.

इति सश्रुत-संहितायामुत्तरतन्त्रे ज्वरप्रतिषेधव्याख्यानाम एकोनचत्वारिंशोऽध्यायः ॥ ३९ ॥

Thus ends the thirty-ninth chapter of the Uttara-Tantra in the Susrutra Samhita which deals with the symptoms and medical treatment of fever.