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ashtanga hridayaJVARA CHIKITSA - Treatment of fever - Ashtanga Hridaya Chapter 1

JVARA CHIKITSA – Treatment of fever – Ashtanga Hridaya Chapter 1

अथातो ज्वरचिकित्सितं व्याख्यास्यामः ।

इति ह स्माहुरात्रेयादयो महर्षयः । We shall now expound the chapter – Jvara chikitsa – treatment of fevers; thus revealed Atreya and other great sages.

Langhana – fasting

आमाशयस्थो हत्वाऽग्निं सामो मार्गान् पिधाय यत् । विदधाति ज्वरं दोषस्तस्मात्कुर्वीत लङ्घनम् ॥ १ ॥

प्राग्रूपेषु ज्वरादौ वा, बलं यत्नेन पालयन् । बलाधिष्ठानमारोग्यमारोग्यार्थः क्रियाक्रमः ॥ २ ॥

The dosas residing in (got localised in) the amasaya (stomach) destroy the fire (digestive activity ), become sama (mixed with undigested materials) obstruct the passages (of rasa dhatu) and produce fevers; therefore, langhana (fasting) should be done either during the premonitory stage or at the commencement of fevers, safeguarding the strength (of the body) with all efforts; health depends on strength and the purpose of treatment is maintainance of health. 1-2.

लङ्घनैः क्षपिते दोषे दीप्तेऽग्नौ लाघवे सति ।

स्वास्थ्यं क्षुत्तृड् रुचिः पक्तिर्बलमोजश्च जायते ॥ ३ ॥

When the dosas become reduced by fasting, the digestive power becomes increased and feeling of lightness of the body appears, health, ( comfort ) , hunger, thirst, desire for food, good digestion, strength and vitality ( enthusiasm) also manifest. 3.

Vamana – emesis

तत्रोत्कृष्टे समुत्क्लिष्टे कफप्राये चले मले। सहृल्लासप्रसेकान्नद्वेषकासविषूचिके ॥४॥

सद्योभुक्तस्य सञ्जाते ज्वरे सामे विशेषतः । वमनं वमनार्हस्य शस्तं कुर्यात्तदन्यथा ॥ ५॥

श्वासातीसारसम्मोहहृद्रोगविषमज्वरान् पिप्पलीभिर्युतान् गालान् कलिङ्गैर्मधुकेन वा ॥ ६ ॥

उष्णाम्भसा समधुना पिबेत्सलवणेन वा । पटोलनिम्बकर्कोटवेत्रपत्रोदकेन वा ॥ ७॥

तर्पणेन रसेनेक्षोर्मद्यैः कल्पोदितानि वा । वमनानि प्रयुञ्जीत बलकालविभागवित् ॥ ८ ॥

When the increased dosas have moved out of their seats but not gone out (of the body), when kapha is predominant, when the dosas which are circulating have given rise to oppression in the region of the heart (nausea), more of salivation, aversion to food, cough, visucika (vomitting and diarrhoea simultaneously), when the fever manifests immediately after meals, when the fever is sama (accompained with symptoms of ama) then vamana (emesis therapy) is especially ideal to those who are suitable for emesis therapy.

If admininstered otherwise (apart from the above conditions) it (emesis ) gives rise to dyspnoea, diarrhoea, delusion, pain in the heart and irregular (remittant and intermittant) fevers.

Gala (madanaphala) mixed with either pippali, kalinga or madhuka should be consumed either with honey or with salt followed by drinking of either warm water; water boiled with patola, nimba, karkota, or vetrapatra; or with nutreint materials or sugar-cane juice or wines; or by other methods described in kalpasthana (chapter 1, verses 1-18), thus the emesis therapy should be administered, carefully considering the strength (of the patient and the disease) and time (season, period of the day). 4-8.

कृतेऽकृते वा वमने ज्वरी कुर्याद्विशोषणम् । दोषाणां समुदीर्णानां पाचनाय शमाय च ॥ ९ ॥

दोषेण भस्मनेवाग्नौ छन्नेऽन्नं न विपच्यते। तस्मादादोषपचनाज्ज्वरितानुपवासयेत् ॥१०॥

Whether emesis therapy is administered or not, the patient of fever should undergo fasting, for cooking the increased dosas and also for mitigating them.

Just as the fire covered with ash does not cook the food material (in the pot kept over the oven) similarly the digestive fire covered with the increased dosas; so the patient of fever should be made to fast till the dosas get fully cooked. 9-10.

Ushnambu pana – drinking of warm water

तृष्णगल्पाल्पमुष्णाम्बु पिबेद्वातकफज्वरे । तत्कफं विलयं नीत्वा तृष्णामाशु निवर्तयेत् ॥ ११ ॥

उदीर्य चाग्निं स्त्रोतांसि मृदूकृत्य विशोधयेत् । लीनपित्तानिलस्वेदशकृन्मूत्रानुलोमनम् ॥१२॥

निद्राजाड्यारुचिहरं प्राणानामवलम्बनम् । विपरीतमतः शीतं दोषसङ्घातवर्द्धनम् ॥ १३ ॥

In fevers caused by vata and kapha, the patient if thirsty, should drink little quantities of warm water often; it liquifies the kapha, relieves thirst quickly, kindles the digestive activity, softens the passages ( of dosas) and cleanses them, initiates the expulsion of stagnated pitta, anila ( vata), sweat, faeces, and urine, dispels sleep, lassitude, and loss of appetite and gives support to life activities. Cold water (on the other hand) is opposite (in actions) and gives rise to further increase of collection of dosas (group of dosas, ama etc.). 11-13.

उष्णमेवंगुणत्वेऽपि युञ्यान्नैकान्तपित्तले । उद्रिक्तपित्ते विषमद्योत्थिते ग्रीष्मे क्षतक्षीणेऽस्त्रपित्तिनि । दवथुदाहमोहातिसारिणि ॥ १४ ॥

Though warm water is having these ( good ) qualities, it should not be made use of in fever caused by pitta alone, not when there is great increase of pitta (in other kinds of fevers), burning sensation in the eyes and the whole body, delusion and diarrhoea; not in fevers caused by poisons and wine; not during summer, and in patients suffering from injury to the lungs, emaciation and bleeding disease. 14-15a.

Sadanga paniya

घनचन्दनशुण्ठ्यम्बुपर्पटोशीरसाधितम् शीतं तेभ्यो हितं तोयं पाचनं तृडज्वरापहम् ।

For those persons (patients of fever enumerated above) water boiled with ghana, candana, sunthi, ambu, parpata and usira and then cooled is suitable; it digests (the undigested materials), relieves thirst and fever. 15-16a.

ऊष्मा पित्ताद्दते नास्ति ज्वरो नास्त्यूष्मणा विना ॥ १६ ॥

तस्मात्पित्तविरुद्धानित्यजेत् पित्ताधिकेऽधिकम् । स्नानाभ्यङ्गप्रदेहांश्च परिशेषं च लङ्घनम् ॥ १७ ॥

There is no (increase of) temperature without (the increase of) pitta and there is no fever without (increase of) temperature; hence in fevers all things (foods, activities etc.) which cause increase of pitta should be avoided, especially so (with greater intent) in fever where pitta is greatly increased. Similarly bath, oil massage, anointing the body (with fragrant pastes) and other methods of langhana (making the body thin and light) should also be avoided). 16b-17.

Notes: The term ‘Viruddha’ is not used here in its popular meaning as “opposite” but used in its technical meaning as that which causes slight increases of the dosa in its own seat but does not expel it out” (defined in verse no. 45 of chapter 7 of Sutrasthana). The other methods of langhana are: the purifactory therapies, physical exercises, exposure to sun and breeze etc. (vide chapter 14 of sutrasthana).

अजीर्ण इव शूलघ्नं सामे तीव्ररुजि ज्वरे | न पिबेदौषधं तद्धि भूय एवाममावहेत् ॥ १८ ॥ आमाभिभूतकोष्ठस्य क्षीरं विषमहेरिव ।

Just as in the disease ajirna (indigestion) pain killing drugs should not be administerd even though there is severe pain, so also in sama jvara (fever which is accompanied with symptoms of ama) medicines (such as fresh juices, decoctions, powders, etc. of drugs) should not be consumed, because these will further increse the ama which is already accumulating in the alimentry tract; just as milk fed to a serpent (only increases the poision). 18-19a.

सोदर्दपीनसश्वासे जङ्घापर्वास्थिशूलिनि ॥ १९ ॥

वातश्लेष्मात्मके स्वेदः प्रशस्तः स प्रवर्तयेत् । स्वेदमूत्रशकृद्वातान् कुर्यादग्नेश्च पाटवम् ॥ २० ॥

स्नेहोक्तमाचारविधिं सर्वशश्चानुपालयेत् ।

In fevers manifesting with udarda (rashes on the skin appearing with contact of cold things), pinasa (chronic rhinitis), dyspnoea, pain in the calves, joints and bones; and in fevers caused by vata, and slesman (kapha), svedana (diaphoresis/sudation therapy) is ideal; that will help the elimination of sweat, urine, faeces and vata (flatus) and improves the strength of the fire ( digestive activity ). The patient should adhere to the regimen described for oleation therapy fully (vide. verses 26-28 of chapter 16 of sutrasthana).

Jvara chikitsa krama – order of treatments of fevers

लङ्घनं स्वेदनं कालो यवाग्वस्तिक्तको रसः ॥ २१ ॥ मलानां पाचनानि स्युर्यथावस्थं क्रमेण वा ।

Langhana (fasting), svedana (sudation, diaphoresis), kala (awaiting time), yavagu (drinking of thin gruel), use of (drugs) of bitter taste and pacana (drugs) which cook (transform by heat) the dosas-these should be administered either as suitable to the stages (of fever) or in successive order. 21b-22a.

शुद्धवातक्षयागन्तुजीर्णज्वरिषु नेष्यते तेषु हि हितं शमनं यन्न कर्शनम् । लङ्घनम् ॥२२॥

Langhana (fasting) is not desirable in fevers caused by vata alone, in that caused by consumption, that due to external agencies and in that which has become chronic. For these, samana ( mitigating the dosas) therapy which does not cause weakness of the body is suitable. 22b-23a.

तत्र सामज्वराकृत्या जानीयादविशोषितम् ॥ २३ ॥ द्विविधोपक्रमज्ञानमवेक्षेत लङ्कने । च

By the presence of symptoms of sama jvara (vide. verse no 54 / of chapter 2 of nidanasthana ), the inadequacy of langhana therapy should be presumed, and its adequacy by the presence of symptoms of proper langhana therapy as described in the dvividhopakrama chapter (14 of sutrasthana). 23b-24a.

Peyadi krama – regimen of liquid diet

युक्तं लङ्कितलिङ्गैस्तु तं पेयाभिरुपाचरेत् ॥ २४ ॥

यथास्वौषधसिद्धाभिर्मण्डपूर्वाभिरादितः षडहं वा मृदुत्वं वा ज्वरो यावदवाप्नुयात् ॥ २५ ॥

तस्याग्निर्दीप्यते ताभिः समिद्भिरिव पावकः ।

When the patient is found to have developed the symptoms of proper langhana therapy, he should be treated next, with administration of peya etc. ( drinking of gruel), prepared with drugs appropriate to each dosa commencing first with manda, either for six days or till the fever become soft ( mild). By these (different kinds of gruel) his digestive fire gets increased just as the ( external) fire, by the faggots ( small pieces of wood). 24b-26a.

Notes : Manda, peya, yavagu, and odana are the liquid, semisolid and solid foods. Manda has fluid only and no boiled grains, peya has more of fluid and less of grains vayagu has fluid and boiled grains in almost equal proportion; vilepi has more of boiled grains and less of fluid and odana is only boiled grains without any liquid portion in it.

प्राग्लाजपेयां सुजरां सशुण्ठीधान्यपिप्पलीम् ॥ २६ ॥

ससैन्धवां, तथाऽम्लार्थी तां पिबेत्सह दाडिमाम् । सृष्टविड् बहुपित्तो वा सशुण्ठीमाक्षिकां हिमाम् ॥ २७ ॥

बस्तिपार्श्वशिरःशूली व्याघ्रीगोक्षुररसाधिताम् । पृश्रिपर्णी बलाबिल्वनागरोत्पलधान्यकैः ॥ २८ ॥

सिद्धां ज्वरातिसार्यम्लां पेयां दीपनपाचनीम् ।

ह्रस्वेन पञ्चमूलेन हिक्कारुक्श्वासकासवान् ॥ २९ ॥

First, laja peya ( thin gruel prepared with fried paddy) processed (boiled) with sunthi, dhanya, pippali and saindhava, which is easily digestable, should be consumed. Those desirous of sour taste may take it with dadima. If there is diarrhoea or great increase of pitta, it can be mixed with sunthi and honey and consumed cold. If there is pain in the region of the bladder, flanks and head, it can be processed (boiled) with vyaghri and goksura, That processed with prsniparni, bala, bilva, nagara, utpala, dhanyaka, and added with little of sour, should be consumed when both fever and diarrhoea are present together, that acts as dipana (improves hunger) and pacana (cooks the undigested materials). That processed with hrasva pancamula drugs is suitable for those who have hiccup, pain ( in the body ), dyspnoea and cough. 26b-29.

पञ्चमूलेन महता कफार्तो यवसाधिताम् । विबद्धवर्चा: सयवां पिप्पल्यामलकैः कृताम् ॥ ३० ॥

यवागूं सर्पिषा भृष्टां मलदोषानुलोमनीम् । चविकापिप्पलीमूलद्राक्षामलकनागरैः कोष्ठे विबद्धे सरुजि पिबेत्तु परिकर्तिनि । कोलवृक्षाम्लकलशीधावनीश्रीफलैः कृताम् ॥ ३२ ॥ ॥३१॥

सितामलकनागरैः । अस्वेदनिद्रस्तृष्णार्तः सिताबदरमृद्वीकासारिवामुस्तचन्दनैः तृष्णाच्छर्दिपरीदाहज्वरघ्नीं ॥३३॥

क्षौद्रसंयुताम् । रसयूषादिकानपि ॥ ३४ ॥ कुर्यात्पेयौषधैरेव

He, who has predominance of kapha should consume yavagu prepared from yava and processed (boiled) with drugs of mahat pancamula. If there is constipation, it can be prepared from yava fried in ghee and then processed with pippali and amalaka, this will help elimination of faeces and the dosas. If there is painful obstruction in the alimentary tract, (yavagu) can be processed with cavika, pippalimula, draksa, amalaka and nagara. If there is cutting pain in the alimentary tract especially the rectum, it (yavagu) should be processed with kola, vrksamla, kalasi, dhavani and sriphala. He who is suffering from absence of perspiration, sleep and thirst should take it ( yavagu) processed with sita (sugar), amalaka and nagara, or with sita ( sugar), badara, mrdvika, sariva, musta and candana, and mixed with honey; this cures thirst, vomitting, burning sensation all over the body and fever.

Rasa (meant soup ) and yusa ( soup of grains) can also be processed with the drugs mentioned for processed peya 30-34. and consumed.

मद्योद्भवे मद्यनित्ये पित्तस्थानगते कफे। ग्रीष्मे तयोर्वाऽधिकयोस्तृछर्दिर्दाहपीडिते ।। ३५ ।।

ऊर्ध्वं प्रवृत्ते रक्ते च पेयां नेच्छन्ति तेषु तु । ज्वरापहै: फलरसैरद्भिर्वा लाजतर्पणान् ॥ ३६ ॥

पिबेत्सशर्कराक्षौद्रान् ततो जीर्णे तु तर्पणे । यवाग्वां वौदनं क्षुद्वानश्रीयाद्धृष्टतण्डुलम् ॥ ३७ ॥

दकलावणिकैर्यूषै रसैर्वा मुद्गलावजैः । इत्ययं षडहो नेयो बलं दोषं च रक्षता ॥ ३८ ॥

Peya should not be given to patients of fever caused by drinking wine, who consume wine daily, when kapha has travelled to the seats of pitta, during summer, when these (pitta and kapha) are greatly increased, when the patient is troubled with thirst, vomitting, burning sensation and bleeding from the upper parts of the body (nose, mouth, eyes, ears etc.). For these, laja tarpana (paste of fried paddy) mixed with the juice of fruits which are anti-fever (such as draksa etc.) or with plain water mixed with sugar and honey, should be given to drink.

Next, when this gets well digested and when he feels hungry he can be given either with yavagu or odana prepared by fried rice to be consumed either with yusa (soup) of kulattha and other pulses) which is watery and salted or with soup of mudga or meat of lava bird.

In this manner, the patient should be taken care of for six days, preserving his strength and (condition of ) the dosas. 35-38.

ततः पक्केषु दोषेषु लङ्घनाद्यैः प्रशस्यते । कषायो दोषशेषस्य पाचनः शमनोऽथवा ॥

३९ ॥

Next, when the dosas have become cooked ( ripe ) by langhana (fasting ) etc., administration of kasaya (medicinal recipes such as fresh juice, infusion, decoction, nice powder of drugs) is necessary either to cook the remnants (residue ) of the dosas or to mitigate them. 39.

तिक्तः पित्ते विशेषेण प्रयोज्यः, कटुकः कफे । पित्तश्लेष्महरत्वेऽपि कषायः स न शस्यते ॥ ४० ॥

नवज्वरे, मलस्तम्भात्कषायो विषमज्वरम् । कुरुतेऽरुचिहृल्लासहिध्मानादिकानपि ॥ ४१ ॥

Medicinal recipes of bitter taste should be used especially for pitta and of pungent taste for kapha. Recipes of drugs of astringent taste are not suitable in fevers of recent onset, even though these are mitigators of pitta and slesman (kapha), astringent taste by producing obstruction to (expulsion of) mala ( dosas) gives rise to irregular ( remittant and intermittant) fevers, loss of taste ( and appetite), nausea, hiccup, flatulence etc. 40-41.

सप्ताहादौषधं केचिदाहुरन्ये केचिदाहुरन्ये दशाहतः । केचिल्लध्वन्नभुक्तस्य योज्यमामोल्वणे न तु ॥ ४२ ॥

तीव्रज्वरपरीतस्य दोषवेगोदये यतः । दोषेऽथवाऽतिनिचिते तन्द्रास्तैमित्यकारिणि ॥ ४३ ॥

अपच्यमानं भैषज्यं भूयो ज्वलयति ज्वरम् ।

Some authorities say that medicines (antifebrile) should be administered after seven days; others say, after ten days, yet others say that it can be given when the patient is taking light foods. It should not be administered when there is increased (production of ) ama (undigested materials).

When the patient is having very high fever, when the movement of dosas have commenced, when there is great accumulation of dosas (and also of ama) producing stupor and inactivity, the medicine, if administered, not undergoing 42-44a. digestion, leads to greater increase of fever.

मृदुर्ज्वरो लघुर्देहश्चलिताश्च मला यदा ॥ ४४ ॥ अचिरज्वरितस्यापि भेषजं योजयेत्तदा ।

If the fever is mild, there is feeling of lightness of the body, and (normal) movement of wastes ( faeces, urine, flatus) then, medicines can be administered even though the fever is of recent onset. 44b-45a.

Ausadha yogas in jvara – medicinal recipes for fever

मुस्तया पर्पटं युक्तं शुण्ठ्या दुःस्पर्शयाऽपि वा ॥ ४५ ॥

पाक्यं शीतकषायं वा पाठोशीरं सवालकम् । पिबेत्तद्वच्च भूनिम्बगुडूचीमुस्तनागरम् ॥ ४६ ॥

यथायोगमिमे योज्याः कषाया दोषपाचनाः । ज्वरारोचकतृष्णास्यवैरस्यापक्तिनाशनाः ॥४७॥

Hot infusion or cold infusion prepared from musta and parpata or sunthi and duh-sparsa or patha, usira and valaka; or bhunimba, guduci, musta and nagara can be consumed.

These, used appropriately (relevent to the dosas) bring about ripening of the dosas and releif of fever (high temperature) loss of taste (and appetite), thirst, bad taste in the mouth and indigestion. 45b-47.

कलिङ्गका पटोलस्य पत्रं कटुकरोहिणी ॥ ४८ ॥

पटोलं सारिवा मुस्ता पाठा कटुकरोहिणी ।

पटोलनिम्बत्रिफलामृद्वीकामुस्तवत्सकाः किराततिक्तममृता चन्दनं विश्वभेषजम् ।

धात्रीमुस्तामृताक्षौद्रमर्धश्लोक समापनाः ॥ ५० ॥

पञ्चैते सन्ततादीनां पञ्चानां शमना मताः ।॥ ४९ ॥

Decoction of drugs of the following five half-verses bring about the mitigation ( cure) of the five kinds of fever, commencing with santata, respectively.

1. Kalingaka, patolapatra and katukarohini (for santata jvara),

2. Patola, sariva, musta patha and katukarohini (for satata jvara),

3. Patola, nimba, triphala, mridvika, musta and vatsaka ( for anyeduska javara ),

4. Kiratatikta, amrta, candana and visvabhesaja (for tritiyaka jvara),

5. Dhatri, musta, amrta and ksaudra (honey) (for caturthaka jvara). 48-51a.

दुरालभामृतामुस्तानागरं वातजे ज्वरे ॥ ५१ ॥

पिप्पलीमूलगुडूचीविश्वभेषजम् । अथवा

कनीयः पञ्चमूलं च पित्ते शक्रयवाघनम् ॥ ५२ ॥

कटुका चेति सक्षौद्रं मुस्तापर्पटकं तथा । सधन्वयासभूनिम्बं वत्सकाद्यो गणः कफे ॥ ५३॥

वृषगाङ्गेयी शृङ्गबेरदुरालभाः ।

For vataja jvara (fever caused by increased vata) decoctions of either duralabha, amrta, musta and nagara; or of pippalimula, guduci, and visvabhesaja; or of the drugs of kaniya (hrasva) pancamula (are best suited).

For pittajvara, decoction of either of sakrayava (indrayava), ghana and katuka mixed with ksaudra (honey); or of musta and parpataka; or of dhanvayasa and bhunimba (mixed with honey) are best suited.

For kapha jvara-decoction of drugs of vatsakadigana (vide chapter 15 of sutrasthana); or of vrsa, gangeyi, Srngavera and duralabha (are best suited). 51b-54a.

रुग्विबन्धानिलश्लेष्मयुक्ते दीपनपाचनम् ॥ ५४॥ अभयापिप्पलीमूलशम्याककटुकाघनम्

When there is pain ( in the body ) constipation, predominance of anila (vata ) and slesman (kapha) together, the decoction of abhaya, pippalimula, samyaka, katuka and ghana, acts as dipana (carminative) and pacana (digestive).

Draksadi phanta

द्राक्षामधूकमधुकरोधकाश्मर्यसारिवाः मुस्तामलकहीबेरपद्मकेसरपद्मकम् मृणालचन्दनोशीरनीलोत्पलपरूषकम् फाण्टो हिमो वा द्राक्षादिर्जातीकुसुमवासितः ।

युक्तो मधुसितालाजैर्जयत्यनिलपित्तजम् ॥ ५७ ॥

ज्वरं मदात्ययं छर्दि मूर्च्छा दाहं श्रमं भ्रमम् । ॥५५॥॥ ५६ ॥

ऊर्ध्वगं रक्तपित्तं च पिपासां कामलामपि ॥ ५८ ॥

Phanta (hot infusion) or hima (cold infuion) prepared from draksa, madhuka, rodhra, kasmarya, sariva, musta, amalaka, hribera, padmakesara, padmaka, mrnala, candana, usira, nilotpala and parusaka ( each equal in quantity ), made fragrant with the addition of jatikusuma (flowers of jasmine) mixed with honey, sugar and laja (fried paddy); this Draksadi phanta, when consumed cures fever due to anila (vata) and pitta (increasing simultaneously) and alcohlism, vomitting, fainting, burning sensation, exertion, even giddiness, bleeding from upper passages, severe thirst and jaundice. 55b-58.

पाचयेत्कटुकां पिष्ट्वा कर्परेऽभिनवे शुचौ | निष्पीडितो घृतयुतस्तद्रसो ज्वरदाहजित् ॥ ५९ ॥

Katuka, made into a paste (with water ) is cooked by keeping it on a fresh and clean potsherd; after cooking, the juice extracted from it, mixed with ghee and consumed cures fever and burning sensation. 59.


वचातिक्तापाठारग्वधवत्सकाः ।

पिप्पलीचूर्णयुक्तो वा क्वाथश्च्छिन्नोद्भवोद्भवः ॥ ६० ॥

In fevers of kapha-vata origin, decoction of vaca, tikta, patha, aragvadha and vatsaka, added with powder of pippali or decoction of chinnodbhava (added with pippali powder) should be consumed. 60.

व्याघ्रीशुण्ठ्यमृताक्वाथः पिप्पलीचूर्णसंयुतः । वातश्लेष्मज्वरश्वासकासपीनसशूलजित् ॥ ६१॥

Decoction of vyaghri, sunthi and amrta added with powder of pippali cures fevers of vata-slesma origin, dyspnoea, cough, pinasa ( rhinitis) and abdominal pain. 61.

पथ्याकुस्तुम्बरीमुस्ताशुण्ठीकतॄणपर्पटम् । सकट्फलवचाभार्ङ्गदेवाह्वं मधुहिङ्गुमत् ॥६२॥

कफवातज्वरष्ठीवकुक्षिहृत्पार्श्ववेदनाः कण्ठामयास्यश्वयथुकासश्वासान्नियच्छति ॥६३॥

Decoction of pathya, kustumburi, musta, sunthi, kattrna, parpata, katphala, vaca, bharngi and devahvam, mixed with madhu (honey) and hingu-cures fever of kaphavata origin, expectoration of sputum, pain in the abdomen, region of the heart and flanks, diseases of the throat, swelling of the face, cough and dyspnoea. 62-63.

आरग्वधादिः सक्षौद्रः कफपित्तज्वरं जयेत् । तथा तिक्तावृषोशीरत्रायन्तीत्रिफलामृताः ॥ ६४ ॥

पटोलातिविषानिम्बमूर्वाधन्ववयवासकाः ।

Decoction of drugs of aragvadhadigana (vide chapter 15 of sutrasthana) added with ksaudra (honey) will cure kaphapittajvara (fever of kaphapitta origin). So also, the decoction of tikta, vrsa, usira, trayanti, triphala, amrta, patola, ativisa, nimba, murva and dhanvayavasaka. 64-65a.

सन्निपातज्वरे व्याघ्रीदेवदारुनिशाधनम् ॥ ६५ ॥

पटोलपत्रनिम्बत्वत्रिफलाकटुकायुतम् । नागरं पौष्करं मूलं गुडूची कण्टकारिका ॥६६॥

सकासश्वासपार्श्वार्तौ वातश्लेष्मोत्तरे ज्वरे । ॥६७॥

मधूकपुष्पमृद्वीकात्रायमाणापरूषकम् सोशीरतिक्तात्रिफलाकाश्मर्यं कल्पयेद्धिमम् ।

कषायं तं पिबन् काले ज्वरान् सर्वानपोहति ॥ ६८ ॥

जात्यामलकमुस्तानि तद्वद्धन्वयवासकम् । बद्धविट् कटुकाद्राक्षात्रायन्तीत्रिफलागुडम् ॥ ६९ ॥

For sannipata jvara, ( fever caused by all the dosas increased simultaneously) vyaghri, devadaru, nisa, ghana, patolapatra, nimbatvak, triphala and katuka (is ideal ). Decoction of nagara, puskaramula, guduci is to be used when there is cough, dyspnoea, pain in the flanks and predominance of vata and kapha in sannipatajvara.

Cold infusion prepared from madhukapuspa, mrdvika, trayamana, parusaka, usira, tikta, triphala and kasmarya, consumed at the proper time cures all types of fevers, similarly so infusion of jati, amalaka, musta and dhanvayavasaka. He who has constipation should drink the infusion of katuka, draksa, tryanti and triphala mixed with guda (molasses). 65-69.

जीर्णौषधोऽन्नं पेयाद्यमाचरेत् श्लेष्मवान्न तु । पेया करूं वर्धयति पङ्कं पांसुषु वृष्टिवत् ॥ ७० ॥

श्लेष्माभिष्यण्णदेहानामतः प्रागपि योजयेत् । यूषान् कुलत्थचणककलायादिकृतान् लघून् ॥ ७१ ॥

रूक्षांस्तिक्तरसोपेतान् हृद्यान् रुचिकरान् पटून् ।

After the medicine is well digested, the regimen of diet commencing with peya should be adopted, except by the person who has more of slesman (kapha), because peya causes increase of kapha just as slush by the rain falling on sand. Hence for persons whose body is heavily moistened by slesman (kapha ), yusa ( soup) of kulattha, canaka, kalaya etc., which is easily digestable, dry ( not mixed with fatty ma terials), bitter in taste, pleasing (agreeable) to the mind, tasty and made salty ( by addition of saindhava salt), should be given at the beginning itself. 70-72a.

Pathya ahara in jvara – suitable foods in fever

रक्ताद्या: शालयो जीर्णाः षष्टिकाश्च ज्वरे हिताः ॥ ७२ ॥

श्लेष्मोत्तरे वीततुषास्तथा वाटीकृता यवाः । ओदनस्तै स्रुतो द्विस्त्रि प्रयोक्तव्यो यथायथम् ॥ ७३ ॥

दोषदृष्यादिबलतो ज्वरघ्रक्वाथसाधितः । मुद्द्राद्यैर्लघुभिर्यूषाः कुलत्थैश्च ज्वरापहाः ॥ ७४ ॥

In fevers, old rice such as raktasali (red rice) etc., and sastika rice are suitable as food. In case of predominance of slesman (kapha), yava (barley) removed of its husk, fried and made into small pieces is ideal.

Odana (rice mess) prepared from rice, washed twice or thrice in water and boiled in the decoction of drugs which are antifebrile should be administered considering carefully the strength of the dosas, dusyas, etc., ( desa, kala, vaya, satmya); yusa (soup) of mudga etc. which are light and of kulattha are curatives of fevers. 72b-74.

कारवेल्लककर्कोटबालमूलकपर्पटैः वार्ताकनिम्बकुसुमपटोलफलपल्लवैः ।। ७५ ।।

अत्यन्तलघुभिर्मांसैर्जाङ्गलैश्च हिता रसाः |

व्याघ्रीपरूषतर्कारीद्राक्षामलकदाडिमैः संस्कृताः पिप्पलीशुण्ठीधान्यजीरकसैन्धवैः ।

सितामधुभ्यां प्रायेण संयुता वा कृताकृताः ॥ ७७ ॥ ॥ ७६ ॥

Rasa (meat soup) prepared from very easily digestable meat of animals of desert-like region processed with karavellaka, karkoti, balamulaka, parpata, vartaka, flowers of nimba, fruits and tender leaves of patola-is best suited; or it (meat soup) may be processed with vyaghri, parusa, tarkari, draksa, amalaka and dadima; or with pippali, sunthi, dhanya,

jiraka and saindhava; each one may be added with sugar and honey; or it (meat soup) may be used processed (with addition of spices and salt) or unprocessed. 75-77.

अनम्लतक्रसिद्धानि रुच्यानि व्यञ्जनानि च ।

अच्छान्यनलसम्पन्नानि अनुपानेऽपि योजयेत् ॥ ७८ ॥

तानि क्वथितशीतं च वारि मद्यं च सात्म्यतः । सज्वरं ज्वरमुक्तं वा दिनान्ते भोजयेल्लघु ॥ ७९ ॥

श्लेष्मक्षयविवृद्धोष्मा बलवाननलस्तदा । यथोचितेऽथवा काले देशसात्म्यानुरोधतः ॥ ८०॥

प्रागल्पवह्निर्भुञ्जानो न ह्यजीर्णेन पीड्यते ।

Vyanjana (lickable menu prepared from vegetables) processed with non-sour butter milk, tasty in nature, thin in constitence and cooked on fire, may be partaken (along with the main food).

Even for, anupana (after-drink) water boiled and cooled or wine, which ever is accustomed may be prescribed.

The patient who is having fever should be asked to take light food at the end of the day, for at that time slesman (kapha) undergoes decrease and the heat of the body increases, then the digestive fire will be powerful (to digest the food); or the food may be taken at such a time as is appropriate to the habitat and accustomisation.

He, who eats earlier ( to the end of the day) when the digestive fire is weak, will he not suffer from indigestion ? (certainly he will). 78-81a.

Sarpihpana in jvara – drinking ghee in fever

कषायपानपथ्यान्नैर्दशाह इति इति लङ्घिते सर्पिर्दद्यात्कफे मन्दे वातपित्तोत्तरे ज्वरे ।

पक्केषु दोषेष्वमृतं तद्विषोपममन्यथा ॥ ८२ ॥

दशाहे स्यादतीतेऽपि ज्वरोपद्रववृद्धिकृत् । लङ्घनादिक्रमं तत्र कुर्यादाकफसङ्क्षयात् ॥८३ ॥

When the body is made light by use of kasaya (medicinal recipes) and suitable regimen of diet for ten days, ghee (medicated) may be given to drink to the patient, of fever

Who has less of kapha and more of vata and pitta; it (ghee) is nector when the dosas are pakva (well processed by heat and not having ama) but is poison when otherwise (dosas are apakva and having ama). Even after the lapse of ten days it (drinking ghee) will cause increase of upadravas (complications, secondary diseases) of fever, then langhana (fasting and other methods of making the body thin) should be adopted till the kapha undergoes decrease completely. 81b-83.

जीर्णोऽनुवर्तते । Due to the poor strength of the tissues of the body the fever becomes chronic and persists long. 84a.

देहधात्वबलत्वाच्च ज्वरो

Notes: The above statement clarifies that the disease-fever does not become chronic, unless the tissues become weak, and that too much of fasting and other debilitating therapies should not be resorted to as these produce weakness of the tissues.

रूक्षं हि तेजो ज्वरकृत्तेजसा रूक्षितस्य च ॥ ८४ ॥ वमनस्वेदकालाम्बुकषायलघुभोजनैः 1

यः स्यादतिबलो धातुः सहचारी सदागतिः ॥ ८५ ॥ तस्य संशमनं सर्पिर्दीप्तस्येवाम्बु वेश्मनः ।

Dry heat only, is the producer of fever, in the person who has been made dry by the heat of fever, sadagati (vata) which is associated with it is very powerful (in function), because of (the effect of) emesis; sudation, lapse of time, drinking of (warm) water medicines and light food, its (of vata) mitigation is (possible only) by drinking of ghee, just as the fire of a burning house (can be extinguished) only by water (poured on it). 84b-86a.

Notes: “Dry heat” here means the Kosthagni-digestive fire devoid of unctousness. Vata which is associated with the digestive fire its samana vata, which becomes more active by emesis and other therapies, ghee bestows unctousness to kosthagni and also helps to diminish the over activity of samana vata, doing both at the same time, hence its importance.

Ghrta sresthata in jvara – importance of ghee in fever

वातपित्तजिताम्यं संस्कारं चानुरुध्यते ॥ ८६ ॥

सुतरां तद्व्यतो दद्याद्यथास्वौषधसाधितम् । विपरीतं ज्वरोष्माणं जयेत्पित्तं च शैत्यतः ॥ ८७ ॥

स्त्रेहाद्वातं घृतं तुल्यं योगसंस्कारतः कफम् । पूर्वे कषायाः सघृताः सर्वे योज्या यथामलम् ॥ ८८ ॥

It (ghee) is foremost among those which overcome vata and pitta, it undergoes change in its qualities fully by processing, hence it should be administered after processing with drugs related to the dosas (to mitigate their increase).

Ghrta (ghee) is antagonistic to the heat of fever, over comes pitta by its coldness, vata by its unctuousness and kapha by processing it with appropriate drugs (which are anti kapha). All the kasayas ( medicinal recipes ) described earlier should be administered mixed with ghee, (made appropriate to the (increased) malas (dosas). 86b-88.

त्रिफलापिचुमन्दत्वड्मधुकं बृहतीद्वयम् ।

समसूरदलं क्वाथ: सघृतो ज्वरकासहा ।। ८९ ॥

Decoction of triphala, bark of picumanda, madhuka, the two brhati and masuradala mixed with ghee cures fever and cough. 89.

Pippalyadi ghrta

पिप्पलीन्द्रयवधावनितिक्ता – सारिवामलकतामलकीभिः ।

बिल्वमुस्तहिमपालनिसेव्यै- द्रक्षयाऽतिविषया स्थिरया च ॥ ९० ॥

घृतमाशु निहन्ति साधितं ज्वरमग्निं विषमं हलीमकम् । अरुचिं भृशतापमंसयोर्वमथुं पार्श्वशिरोरुजं क्षयम् ॥ ९१ ॥

Medicated ghee prepared with pippali, indrayava, dhavani, (kantakari) , tikta, sariva amalaka, tamalaki, bilva, musta, hima, palani (trayamana), sevya, draksa, ativisa and sthira-cures fevers, irregularities of digestion, halimaka (advanced stage of jaundice), loss of taste and appetite, severe burning sensation in the shoulders, vomitting, pain in the flanks and the head and consumption ( tuberculosis) quickly. 90-91.

तैल्वकं पवनजन्मनि ज्वरे योजयेत्त्रिवृतया वियोजितम् । तिक्तकं वृषघृतं च पैत्तिकै यच्च पालनिकया शृतं हविः ॥ १२ ॥

Tailvaka ghrta (vide-chapter 21/32) devoid of trivrt should be administered in fever born of pavana (vata),

Tiktaka ghrta (vide-chapter 19 / 2), Vrsa ghrta (chapter 2 / 40 ) and that processed with palanika in fevers arising from pitta.

Vidangadi ghrta

विडङ्गसौवर्चलचव्यपाठाव्योषाग्निसिन्धूद्भवयावशूकैः । पलांशकैः क्षीरसमं घृतस्य प्रस्थं पचेज्जीर्णकफज्वरघ्नम् ॥ ९३ ॥

Ghee prepared with one pala each of vidanga, sauvarcala, cavya, patha, vyosa, agni, saindhava (salt), yavasuka (spikes of barley) equal quantities of milk and ghee each one prastha. This cures chronic fever arising from kapha. 93.

गुडूच्या रसकल्काभ्यां त्रिफलाया वृषस्य च।

मृद्वीकाया बलायाश्च स्नेहाः सिद्धा ज्वरच्छिदः ॥ ९४ ॥

Ghee prepared with the fresh juice and paste of guduci, (juice and paste of ) triphala, of vrsa, of mrdvika and of bala (thus five recipes seperately) cure fevers. 94.

जीर्णे घृते च भुञ्जीत मृदुमांसरसौदनम् । बलं ह्यलं दोषहरं परं तच्च बलप्रदम् ॥ ९५ ।।

After the medicated ghee is well digested, the patient should eat odana ( boiled rice mess) along with juice ( soup ) of soft meat. Strength ( of the tissues / body ) itself is enough to overcome the dosas and this (rice mess and meat soup), is the best for giving strength. 95.

कफपित्तहरा मुद्गकारवेल्लादिजा रसाः । प्रायेण तस्मान्न हिता जीर्णे वातोत्तरे ज्वरे ॥ ९६ ॥ ज्वरवर्धनाः। शूलोदावर्तविष्टम्भजनना

Soup of mudga, karavella and others generally overcome kapha and pitta, hence not suitable in chronic fevers having predominance of vata, these produce pain in the abdomen, upward movement of vata, constipation and increase of fever. 96-97a.

Sodhana in jvara – purificatory therapies in fever

न शाम्यत्येवमपि चेज्वरः कुर्वीत शोधनम् ॥ ९७ ॥

शोधनार्हस्य, वमनं प्रागुक्तं तस्य योजयेत् । आमाशयगते दोषे बलिन: पालयन्बलम् ॥ ९८ ॥

If even with all these therapies the fever does not subside then sodhana ( purificatory therapies) should be administered to those who are suitable to them.

Vamana (emesis ) should be administered as described earlier when the dosas are localised in the amasaya (stomach) for the patient who is strong, and after safeguarding his strength. 97b-98.

पक्के तु शिथिले दोषे ज्वरे वा विषमद्यजे । मोदकं त्रिफलाश्यामात्रिवृत्पिप्पलिकेसरैः ॥ ९९ ॥

ससितामधुभिर्दद्याह्योषाद्यं वा विरेचनम् । (लिह्याद्वा त्रैवृतं चूर्णं संयुक्तं मधुसर्पिषा ।)

द्राक्षाधात्रीरसं तद्वत्सद्राक्षां वा हरीतकीम् ॥ १०० ॥

आरग्वधं वा पयसा मृद्वीकानां रसेन वा । त्रिफलां त्रायमाणां वा पयसा ज्वरितः पिबेत् ।। १०१ ॥

विरिक्तानां च संसर्गी मण्डपूर्वा यथाक्रमम् ।

In fevers in which the dosas are ripe and loose (not adhering to the tissues and channels) or in fevers caused by poison or wine, modaka (pills) prepared with triphala, syamatrivrt, pippali and kesara, added with sita and madhu may be administered (to produce purgation), or vyosadi ghrta (vide-chapter 2 / 21 of Kalpasthana ), or powder of trivrt) may be licked with honey and ghee, similarly draksa and juice of dhatri or draksa, haritaki or aragvadha (each seperately) may be licked consumed with milk or juice of mrdvika, or either triphala or trayamana along with milk may be consumed by the patient of fever.

After purgation ( and emesis therapies ) samsarjana (regimen of liquid diet) should be adopted commencing with manda, in accordance with the order sequence. 99-102a.

च्यवमानं ज्वरोत्क्लिष्टमुपेक्षेत मलं सदा ।। १०२ ।।

पक्कोsपि हि विकुर्वीत दोषः कोष्ठे कृतास्पदः । अतिप्रवर्तमानं वा पाचयन् सङ्ग्रहं नयेत् ॥ १०३ ।।

आमसग्रहणे दोषा दोषोपक्रम ईरिताः । पाययेद्दोषहरणं मोहादामज्वरे तु यः ॥ १०४ ॥ ॥

प्रसुप्तं कृष्णसर्पं स कराग्रेण परामृशेत् ।

If by the effect of fevers, the wastes ( feaces, urine etc.) are going out of the body always (frequently) they should be neglected (not stopped by drugs or diet) even though they are well cooked; if stopped, they remaining inside the alimentary tract give rise to abnormal symptoms. If there is too much of eliminiation it may be controlled by administering pachana (digestive medicines), the harmful effects of the wastes which are in ama (unripe) state have already been described in the doshopakrama (chapter 13 of sutrasthana), (so it should not be stopped). He (the physician) who by lack of knowledge administers purifactory drugs in amajvara (fever in which there is accumulation of undigested materials in the alimentary tract and rasa dhatu) will only be touching (waking) a sleeping black cobra with his fingers. 102b-105a.

Kshirapana – drinking milk

ज्वरक्षीणस्य न हितं वमनं न विरेचनम् ॥ १०५ ॥

कामं तु पयसा तस्य निरूहैर्वा हरेन्मलान् । क्षीरोचितस्य प्रक्षीणश्लेष्मणो दाहतृड्वतः ।। १०६ ।।

क्षीरं पित्तानिलार्तस्य पथ्यमप्यतिसारिणः । तद्वपुर्लङ्घनोत्तप्तं वनमिवाग्निना ।। १०७॥

प्लुष्टं दिव्याम्बु जीवयेत्तस्य ज्वरं चाशु नियच्छति । संस्कृतं शीतमुष्णं वा तस्माद्धारोष्णमेव वा ।। १०८ ।।

विभज्य काले युञ्जीत ज्वरिणं हन्त्यतोऽन्यथा |

For him, who is debilitated by fever, neither emesis nor purgation therapy is suitable, the waste products may be expelled out, if necessary by either milk (drinking) or by a niruha (decoction enema).

For him, who is accustomed to milk, in whom there is great decrease (or loss) of slesman (kapha), who is suffering from burning sensation and thirst, who is troubled by increase of pitta and anila (vata), whom milk is suitable, even for him who has diarrhoea. It invigorates the body which has become weak by langhana (fasting and other thinning therapies) just as rain water helps the (growth of the) forest which has been destroyed by fire. It cures fever soon.

Hence milk processed (boiled with appropriate drugs) consumed cold or warm, or warm milk direct from the cows, should be administered to a patient with fevers carefully considering the time ( season, time of the day and night, stage of fever etc.), otherwise (administeted in any other 105b-109a. manner) it will kill him.

पयः शृतशीतं तद्वद्स शुण्ठीखर्जूरमृद्वीकाशर्कराघृतम् ॥ १०९ ॥

मधुयुतं तुड्दाहज्वरनाशनम् । द्राक्षाबलायष्टीसारिवाकणचन्दनैः ॥ ११० ॥

चतुर्गुणेनाम्भसा वा पिप्पल्या वा शृतं पिबेत् ।

Milk boiled with sunthi, kharjura, mrdvika, sugar and ghee, then cooled and consumed mixed with honey will relieve thirst, burning sensation and fever.

Milk boiled with draksa, bala, yasti, sariva, kana and candana acts likewise.

It (milk) may be boiled with water four times its quantity (and reduced to a quarter) or may be boiled with pippali and consumed.

कासाच्छ्छ्रासाच्छिरःशूलात्पार्श्वशूलाच्चिरज्वरात् ॥ १११ ॥

मुच्यते ज्वरितः पीत्वा पञ्चमूलीशृतं पयः । शृतमेरण्डमूलेन बालबिल्वेन वा ज्वरात् ॥ ११२ ॥

धारोष्णं वा पयः पीत्वा विबद्धानिलवर्चसः । सरक्तपिच्छातिसृतेः सतृशूलप्रवाहिकात् ॥ ११३ ॥

The patient of fever gets relieved of cough, dyspnoea, headache, pain in the flanks and chronic fever by drinking milk boiled with ( drugs of ) panchamula, by drinking milk boiled either with roots of eranda or tender fruits of bilva. By drinking warm milk direct from the cows udder, the patient of fever gets relieved of obstruction of flatus and faeces, diarrhoea with more of blood and mucus, thirst, pain in the abdomen and straining at stools.

Milk and guda

॥११४॥ सिद्धं शुण्ठीबलाव्याघ्रीगोकण्टकगुडैः पयः ।

शोफमूत्रशकृद्वातविबन्धज्वरकासजित् वृश्चीवबिल्ववर्षाभूसाधितं ज्वरशोफनुत् ।

शिंशिपासारसिद्धं च क्षीरमाशु ज्वरापहम् ।। ११५ ।।

processed with sunthi, bala, vyaghri, gokantaka (added) relieves oedema, obstruction of urine, faeces and flatus, fever and cough, boiled with vrisciva, bilva and varsabhu, it relieves fever and oedema, milk processed with the extract of simsipa cures fever quickly. 114-115.

Basti prayoga in jwara – enema therapy in fever

निरूहस्तु बलं वह्निं विज्वरत्वं मुदं रुचिम् ।

दोषे युक्तः करोत्याशु पक्के पक्काशयं गते ॥ ११६ ॥

पित्तं वा कफपित्तं वा पक्वाशयगतं हरेत् ।

स्स्रंसनं त्रीनपि मलान् बस्तिः पक्वाशयाश्रयान् ॥ ११७ ॥

Niruha (decoction enema) bestows strength, keen digestive activity, relief of fever, comfort and desire (in food, activities etc.) if administered appropriately when the doshas are ripe and localised in the pakvasaya (large intestines). Sramasana (mild prugative therapy) removes the pitta or Kapha pitta only localised in the pakvasaya, whereas basti (enema therapy) removes all the three malas (dosas) localised in the pakvasaya. 116-117.

प्रक्षीणकफपित्तस्य दीप्ताग्नेर्बद्धशकृतः

त्रिपृष्ठकटिग्रहे । प्रयुञ्जीतानुवासनम् ॥ ११८ ॥

Anuvasana (oil enema) should be administered (to a patient of fever) who has severe depletion of kapha and pitta, has catching pain in the upper portion of the back and central portion of the back and waist, who has increased digestive activity and constipation. 118.

पटोलनिम्बच्छदनकटुकाचतुरङ्गुलैः स्थिराबलागोक्षुरकमदनोशीरवालकैः पयस्यर्धोदके क्वाथं क्षीरशेषं विमिश्रितम् ।

कल्कितैर्मुस्तमदनकृष्णामधुकवत्सकैः बस्तिं मधुघृताभ्यां च पीडयेज्ज्वरनाशनम् । ॥ ११९ ॥ ॥ १२०॥

Leaves of patola, bark of nimba, katuka, caturangula, sthira, bala, goksura, madana, usira and valaka are made into decoction and mixed with twice the quantity of milk, a paste of musta, madana, krsna, madhuka and vatsaka (specified quantity of) honey and ghee are all mixed together and administered as enema, cures fever. 119-121a.

॥ १२१ ॥ चतस्त्रः पर्णिनीर्यष्टीफलोशीरनृपद्रुमान् क्वाथयेत्कल्कयेद्यष्टीशताह्वाफलिनीफलम् मुस्तं च बस्तिः सगुडक्षौद्रसर्पिर्ज्वरापहः ॥ १२२ ॥ ।

Catasra parni ( the four parnis), yasti, phala (madana) usira, nrpadruma (aragvadha) are made into a decoction, a paste of yasti, satahva, phalini (priyangu), phala (madana), and musta, is mixed with the decoction, along with guda (molasses), ksaudra (honey) and sarpi ( ghee) and administered as an enema; this cures fever. 121b-122.

जीवन्तीं मदनं मेदां पिप्पलीं मधुकं वचाम्। ऋद्धिं रास्त्रां बलां बिल्वं शतपुष्पां शतावरीम् ॥ १२३ ॥

पिष्टा क्षीरं जलं सर्पिस्तैलं चैकत्र साधितम् । ज्वरेऽनुवासनं दद्याद्यथास्त्रेहं यथामलम् ॥ १२४ ॥

Jivanti, madana, meda, pippali, madhuka, vaca, rddhi, rasna, bala, bilva, satapuspa and satavari are converted into a paste and mixed with (prescribed quantity of) milk, water, ghee and (sesame) oil and administered as enema, as many times as required to produce unctousness and mitigate the dosas. 123-124.

ये च सिद्धिषु वक्ष्यन्ते बस्तयो ज्वरनाशनाः ।

Even the enema recipes which will be described in the siddhisthana (chapter 4 of kalpasiddhisthana ) also cure fever 125a.

Nasya in jvara – nasal medication in fever

शिरोरुग्गौरवश्लेष्महरमिन्द्रियबोधनम् ॥ १२५॥

जीर्णज्वरे रुचिकरं दद्यान्नस्यं विरेचनम् । स्नेहिकं शून्यशिरसो दाहार्ते पित्तनाशनम् ॥ १२६ ॥

In chronic fevers virechana nasya (purifictory nasal medication) should be administered, that will relieve headache and feeling of heaviness of the head, mitigates slesman (kapha) and augment keenness of the sense organs. The person who has feeling of emptiness of the head and burning sensation, should be administered sneha nasya (oil or lubricating nasal medication) which mitigates pitta. 125b-126.

Dhuma-gandusa prayoga in jvara – inhalation and mouth gargles

धूमगण्डूषकवलान् यथादोषं च कल्पयेत् ।

प्रतिश्यायास्यवैरस्यशिरः कण्ठामयापहान् ॥ १२७ ॥

Dhuma (inhalation of smoke) gandusa (holding liquids in the mouth) and kavala (mouth gargles) appropriate to the dosa may also be administered, these relieve running in the nose, bad taste in the mouth, pain in the head and throat. 127.

अरुचौ मातुलुङ्गस्य केसरं साज्यसैन्धवम् । धात्रीद्राक्षासितानां वा कल्कमास्येन धारयेत् ॥ १२८ ।।

When there is loss of taste, paste of either kesara (fimbrae) of matulunga mixed with ghee and saindhava or paste of dhatri and draksa mixed with sita (sugar) should be held in the mouth (for some time). 128.

Abhyangadi prayoga in jvara – oil massage in fever

यथोपशयसंस्पर्शान् शीतोष्णद्रव्यकल्पितान् । अभ्यङ्गालेपसेकादीन् ज्वरे जीर्ण त्वगाश्रिते ॥ १२९ ॥

कुर्यादञ्जनधूमांश्च तथैवागन्तुजेऽपि तान् ।

Abhyanga (oil bath), alepa (application of medicinal paste) seka (bathing, fomentation) etc. should be done in chronic fevers localised in the skin; so also anjana (application of medicinal collyrium into the eyes) and dhuma (inhalation of smoke of drugs) these therapies should also be done even for agantujvara (fevers caused by external agencies). 129-130a.

दाहे सहस्रधौतेन सर्पिषाऽभ्यङ्गमाचरेत् ॥ १३० ॥

When there is burning sensation, abhyanga should be done with sahasra dhatua ghrta.

Notes: Sahasra dhatu ghrta means ghee washed a thousand times (many time) solid ghee is placed on a broad plate and rubbed with cold water for about an hour, then the water is drained out. Fresh water is added and rubbing continued. This process is repeated for many times. At the end of the process, the ghee becomes very soft and highly cooling. This is applied over the whole body, allowed to stay for about an hour and then washed with warm water. Use of decoction of bark of udumbara instead of water is the practice in vogue.

सूत्रौक्तेश्च गणैस्तैस्तैर्मधुराम्लकषायकैः । दूर्वादिभिर्वा पित्तघ्नैः शोधनादिगणोदितैः ॥ १३१ ॥

शीतवीर्यैर्हिमस्पर्शैः क्वाथकल्कीकृतैः पचेत् । तैलं सक्षीरमभ्यङ्गात्सद्यो दाहज्वरापहम् ॥ १३२ ॥

शिरो गात्रं च तैरेव नातिपिष्टैः प्रलेपयेत् । तत्काथेन परीषेकमवगाहं च योजयेत् ॥ १३३ ॥ तथाऽऽरनालसलिलक्षीरशुक्तघृतादिभिः ।

Medicated oil should be prepared, along with milk and (decoction of) drugs of sweet, sour and astringent groups ( vide chapter 10 of sutrasthana or durvadigana etc. described in sodhanadi gana adhyaya ( chapter 15 of sutrasthana ) which mitigate pitta, which are cold in potency and in touch, made into decoction and pastes. Anointing the body with this oil, quickly cures burning sensation and fever. Both the head and body should be smeared with this oil; without more of paste, this decoction be poured over the body or the patient given a tub bath with it. Rice wash, (cold) water, milk, fermented gruel and / or ghee may also be used similarly. 131-134a.

कपित्थमातुलुङ्गाम्लविदारीरोथ्रदाडिमैः बदरीपल्लवोत्थेन फेनेनारिष्टकस्य वा ।

लिप्तेऽङ्गे दाहरुड्मोहाश्च्छर्दिस्तृष्णाच शाम्यति ॥ १३५ ।।

यो वर्णितः पित्तहरो दोषोपक्रमणे क्रमः । तं च शीलयतः शीघ्रं सदाहो नश्यति ज्वरः ॥ १३६ ॥ ॥ १३४ ॥

Forthy paste prepared from the tender leaves of either kapittha, matulunga, amla, vidari, rodhra, dadima, badari or arista, smeared over the body relieves burning sensation, delusion, pain, vomitting and thirst.

He who adopts the methods which mitigate pitta described in dosopakrama adhyaya (chapter 13 of sutrasthana) gets relieved of fever accompanied with burning sensation quickly. 134b-136.

वीर्योष्णैरुष्णसंस्पर्शैस्तगरागुरुकुङ्कुमैः कुष्ठस्थौणेयशैलेयसरलामरदारुभिः ॥ १३७॥

नखरास्त्रापुरवचाचण्डैलाद्वयचोरकैः पृथ्वीकाशिग्रुसुरसाहिंस्त्राध्यामकसर्षपैः दशमूलामृतैरण्डद्वयपत्तूररोहिषैः ॥ १३८ ॥ । ॥ १३९ ॥

तमालपत्रभूतीकशल्लकीधान्यदीप्यकैः मिशिमाषकुलत्थाग्निप्रकीर्यानाकुलीद्वयैः

अन्यैश्च तद्विधैर्द्रव्यैः शीते तैलं ज्वरे पचेत् ॥ १४० ॥

क्वथितैः कल्कितैर्युक्तैः सुरासौवीरकदिभिः ।

तेनाभ्यञ्जयात्सुखोष्णेन, तैः सुपिष्टैश्च लेपयेत् ॥ १४१ ॥

कवोष्णैस्तैः परीषेकमवगाहं च कल्पयेत् ।

केवलैरपि आरग्वधादिवर्गं तद्वच्च सुक्तगोमूत्रमस्तुभिः ॥ १४२ ॥

पानाभ्यञ्जनलेपने । धूपानगरुजान् यांश्च वक्ष्यन्ते विषमज्वरे ॥ १४३ ॥

अग्न्यनग्निकृतान् स्वेदान् स्वेदि भेषजभोजनम् ।

गर्भभूवेश्मशयनं निर्धूमदीप्तैरङ्गारैर्हसन्तीश्च कुथकम्बलरल्लकान् ॥ १४४ ॥

हसन्तिकाः । मद्यं सत्र्यूष्णं तक्रं कुलत्थव्रीहिकोद्रवान् ॥ १४५ ॥

संशीलयेद्वेपथुमान् यच्चान्यदपि पित्तलम् । दयिताः स्तनशालिन्यः पीना विभ्रमभूषणाः ॥ १४६ ॥

यौवनासवमत्ताश्च तमालिङ्गेयुरङ्गनाः ।

वीतशीतं च विज्ञाय तास्ततोऽपनयेत्पुनः ॥ १४७ ॥

Drugs which are hot in potency and on touch such as tagara, aguru, kunkuma, kustha, sthauneva, saileya, sarala, amaradaru, nakha, rasna, pura, vaca, canda, eladvaya, coraka, prthvika, sigru, surasa, himsra, dhyamaka, sarsapa, dasamula, amrta, eranda dvaya, dipyaka, misi, masa, kulattha, agni, prakirya, nakuli dvaya and others of similar nature are made use of for preparing decoction and paste and medicated oil prepared adding sura, souviraka, etc. (fermented liquors). This oil should be smeared on the body comfortably warm, a nice paste of the above drugs applied warm over the body or their decoction poured over the body or used for tub-bath-these are the treatments for sitajvara (fever with rigors ). Similarly sukta (fermented gruel) cows urine, or mastu ( whey) may be used alone ( without processing with drugs ).

Drugs of aragvadhadi varga (vide chapter 15 of sutrasthana) may be made use for preparing drinking water, oil bath, and application on the skin; fumigation with aguru and others prescribed for visama jvara, sudation (diaphoresis therapy) with or without the use of fire for persons who are suitable for this therapy; use of drugs and foods which produce sweating easily such as remaining inside inner apartments sorrounded by thick walls or which are under the ground, covering the body with blanket and other thick coal, and devoid of smoke; use of wine, buttermilk added with (powder of) tryusana, kulattha, vrihi, and kodrava; these and any others which increase pitta should be adopted by the patient (of fever) having shivering (rigor). Women who have elevated breasts, decorated with jewels, intoxicated with the spirit of youth should embrace him and then withdraw after knowing that he is free from cold (rigors). 137-147.

Sannipata jvara chikitsa – treatment of fever caused by all the dosas

वर्धनेनैकदोषस्य क्षपणेनोच्छ्छ्रितस्य वा । कफस्थानानुपूर्व्या वा तुल्यकक्षाञ्जयेन्मलान् ॥ १४८ ॥

By causing the increase of any one of dosa or by causing the decrease of that which is greatly increased or by treating kaphasthana (seat of kapha) first in the order of precedence, the malas (dosas) which are in equal standard, should be controlled (teated). 148.

Notes This refers to the mode of treatment of sannipata-all the dosas increasing simultaneously. Increase of the dosas will be in three states, vrddhatama- (greatly increased), vrddha tara (moderatately increase and vrddha (mild increase); similarly so is ksaya (decrease), there is also another state, in which the increase of all the dosas are in the same degree. In the former state the dosa which is greatly increased should be brought down by treatment and the dosa which is greatly decreased should be got increased. When all the dosas are in the same degree of increase, kapha should be treated first, next the pitta and then vata; the term ‘sthana’ has two meaning viz-1, state or condition and 2, place or seat. Adopting the second meaning, amasaya (stomach), the seat of kapha has to be cleared first and next seats of pitta and vata. There is difference of opinion on this issue even among the ancient authorities as can be gathered from the commentaries on these texts.

सन्निपातज्वरस्यान्ते कर्णमूले सुदारुणः | शोफः सञ्जायते येन कश्चिदेव विमुच्यते ॥ १४९ ॥

रक्तावसेचनैः शीघ्रं सर्पिः पानैश्च तं जयेत् । प्रदेहैः कफपित्तघ्नैर्नावनः कवलग्रहैः ।। १५० ।।

At the terminal stage of sannipata jvara there develops a dreaded swelling at the root of the ear, from which few will be spared. It should be treated quickly by blood letting, drinking of medicated ghee, warm poultice with drugs which mitigate kapha and pitta, nasal medication and kavala (mouth gargle). 149-150.

शीतोष्णस्निग्धरूक्षाद्यैर्ज्वरो यस्य न शाम्यति । शाखानुसारी तस्याशु मुञ्चेद्वाह्रोः क्रमाच्छिराम् ॥ १५१ ॥

In whom the fever does not subside even after treatments which produce cold or heat, unctousness or dryness and when the fever travels to the sakhas (become localised in the tissues) then the veins of his arm should be cut (to let out blood) quickly, as per procedure. 151.

Vishama jvara chikitsa – treatment of irregular fevers

अयमेव विधिः कार्यो विषमेऽपि यथायथम् ।

ज्वरे विभज्य वातादीन् यश्चानन्तरमुच्यते ।। १५२ ।।

The same methods of treatment (described above) should be adopted even for Visama jvara (remittant and intermittant fevers); by classifying ( determining) the state of increase of vata and others and also the other ( treatments) to be described further on. 152.

पटोलकटुकामुस्ताप्राणदामधुकैः कृताः ।

त्रिचतुः पञ्चशः क्वाथा विषमज्वरनाशनाः ॥ १५३ ॥ Decoction prepared from three, four, or all the five of patola, katuka, musta pranada ( haritaki) and madhuka cures visama jvara. 153.

योजयेत्त्रफलां पथ्यां गुडूचीं पिप्पलीं पृथक् |

तैस्तैर्विधानैः सगुडं भल्लातकमथापि वा ॥ १५४ ॥

Triphala, pathya, guduci and pippali, each seperately should be administered by their own respective procedures; or bhallataka along with guda (molasses ) may be given. 154.

Notes These drugs are to be used adopting the procedure of Rasayana therapy which are described in chapter 39 of Uttarasthana.

लङ्घनं बृंहणं वाऽऽदौ ज्वरागमनवासरे।

प्रातः सतैलं लशुनं प्राग्भक्तं वा तथा घृतम् ॥ १५५ ॥

जीर्णं तद्वद्दधि पयस्तकं सर्पिश्च षट्पलम् । कल्याणकं पञ्चगव्यं तिक्ताख्यं वृषसाधितम् ॥ १५६ ।।

त्रिफलाकोलतर्कारीक्काथे दक्षा शृतं घृतम् । तिल्वकत्वक्कृतावापं विषमज्वरजित्परम् ॥ १५७ ॥

On the day of onset of fever (visama jvara) either langhana (fasting etc. ) or brhmana (nourishing foods etc.) should be adopted first.

In the morning or before food, lasuna together with oil (lasuna in oil) or old ghee should be consumed, fried similarly with either dadhi (curdled milk), milk, buttermilk, or ghee seperately, or satpalaghrta (vide chapter 5 of of chikitsasthana), kalyanaka ghrta ( vide, chapter 6 uttarasthana), tiktaka ghrta (chapter 19 of chikitsasthana) and vrsaghrta (chapter 2 of chikitsasthana) may be consumed.

Decoction of triphala, kola, and tarkari, (four parts) equal quantity of dadhi ( curdled milk ) and ghrta ( ghee ), paste of bark tilvaka, all cooked to form a medicated ghee. This is best to cure visama jvara. 155-157.

सुरां तीक्ष्णं च यन्मद्यं शिखितित्तिरिदक्षजम् । मांसं मेद्योष्णवीर्यं च सहान्नेन प्रकामतः ॥ १५८ ।। सेवित्वा तदहः स्वप्यादथवा पुनरुल्लिखेत् । सर्पिषो महतीं मात्रां पीत्वा वा छर्दयेत्पुनः ॥ १५९ ॥

Strong sura and madya ( alcoholic drinks), meat of peacock, tittari (black partridge) and cock, along with foods which are fatty and hot (inpotency), should be consumed along with rice mess, as much as desired. After eating, the patient should sleep for the whole of day or made to vomit, vomitting may be induced after giving him a drink of ghee in 158-159. the maximum dose.

नीलिनीमजगन्धां च त्रिवृत्तां कटुरोहिणीम् । पिबेज्ज्वरस्यागमने स्नेहस्वेदोपपादितः ॥ १६०॥

Nilini, ajagandha, trivrt, and katurohini-should be consumed on the expected day of fever, after adopting snehana (oleation) and svedana (sudation). 160.

मनोह्वा सैन्धवं कृष्णा तैलेन नयनाञ्जनम् । योज्यं हिङ्गसमा व्याघ्रीवसा नस्यं ससैन्धवम् ॥ १६१ ॥ पुराणसर्पिः सिंहस्य वसा तद्वत्ससैन्धवा ।

Manohva, saindhava and krsna are made into a collyrium (eyesalve) and applied. Hingu and vyaghrivasa (muscle fat of a tigress) equal in quantity, added with saindhava is administered as nasal drops; or old ghee and muscle-fat of a lion added with saindhava may be used similarly. 161-162a.

पलङ्कषा निम्बपत्रं वचा कुष्ठं हरीतकी ॥ १६२ ॥ सर्षपाः सयवाः सर्पिर्धूपो विड्वा बिडालजा |

Palankasa, leaves of nimba, vaca, kustha, haritaki, sarsapa and yava mixed with ghee should be used for fumigation; or it may be done with excreta of cat. 162b-163a. Aparajita dhupa

पुरध्यामवचासर्जनिम्बार्कागरुदारुभिः ॥ १६३ ॥ धूपो ज्वरेषु सर्वेषु कार्योऽयमपराजितः । धूपनस्याञ्जनोत्रासा ये चोक्ताश्चित्तवैकृते ॥ १६४ ॥ देवाश्रयं च भैषज्यं ज्वरान् सर्वान् व्यपोहति । विशेषाद्विषमान् प्रायस्ते ह्यागन्त्वनुबन्धजाः ॥ १६५ ॥

Purva, dhyama, vaca, sarja, nimba, arka, aguru, and daru, may be used for fumigation in all types of fevers. This is known as Aparajita dhupa.

(Recipes of) Fumigation, nasal medication, eye-salves, and methods of sudden threatening of the patient, described in the (treatment of) disorders of the mind may also be adopted (in visama jvara).

Daivasraya (providential) therapies cure all kinds of fevers, especially the visama jvara ( irregular fevers) because these are usually produced by external agencies. 163b-165. Notes: Daiva vyapasraya treatment includes mantra (chanting of sacred hymns) ausadha ( wearing of precious herbs) mani ( wearing of amulets, precious stones etc.) mangala (auspicious rites), bali (offering things to please gods etc.), upahara ( giving gifts ) , homa ( fire sacrifice ), niyama (vow, voluntary penance, abstaining from desires ) , prayascitta (expiciation, intentional suffering) upavasa (fasting) svastyayana (auspicious benediction, blessings by gods, saints etc.) pranipata gamana (bowing to the feet of gods, saints, preceptors, etc., going on piligrimage to holy places) and such other acts.

Siravyadha in jvara – venesection

यथास्वं च सिरां विध्येदशान्तौ विषमज्वरे । केवलानिलवीसर्पविस्फोटाभिहतज्वरे ॥ १६६ ॥

सर्पिः । पानहिमालेपसेकमांसरसाशनम् कुर्याद्यथास्वमुक्तं च रक्तमोक्षादि साधनम् ॥ १६७॥

If visama jvara does not get cured, then the veins should be cut (to let out blood) as and how desired (for the aggravated dosa). In fevers caused by anila (vata), alone, visarpa (herpes) visphota ( small pox) and trauma, therapies such as drinking of medicated ghee, cold application (of paste of drugs), pouring decoction of drugs on the body, consuming food along with juice (soup) of meat and blood letting should be adopted as suitable to the respective dosa. 166-167.

Agantu jvara chikitsa – treatment of fever due to external agents

ग्रहोत्थे भूतविद्योक्तं बलिमन्त्रादि साधनम् । विषजिद्विषे ॥ १६८ ॥

ओषधीगन्धजे पित्तशमनं इष्टैरर्थैर्मनोज्ञैश्च यथादोषशमेन च। हिताहितविवेकैश्च ज्वरं क्रोधादिजं जयेत् ॥ १६९ ॥

क्रोधजो याति कामेन शान्तिं क्रोधेन कामजः । भयशोकोद्भवौ ताभ्यां भीशोकाभ्यां तथेतरौ ॥ १७० ॥

शापथर्वणमन्त्रोत्थे विधिदैवव्यपाश्रय । ते ज्वराः केवला: पूर्वं व्याप्यन्तेऽनन्तरं मलैः ॥ १७१ ॥

तस्माद्दोषानुसारेण तेष्वाहारादि कल्पयेत् । न हि ज्वरोऽनुबन्धाति मारुताद्यैर्विना कृतः ॥ १७२ ॥

ज्वरकालस्मृतिं चास्य हारिभिर्विषयैर्हरेत् । करुणार्द्रं मनः शुद्धं सर्वज्वरविनाशनम् ॥ १७३ ॥

For fevers caused by graha (evil spirits, bacteria etc.) measures such as bali (offering oblations), mantra (incantation of hymns) etc., described in Bhuta vidya (sorcery) are the methods of treatment. For fever caused by the smell of plants, therapies which mitigate pitta, should be adopted, and for fevers caused by poison, antipoisonous therapies.

Fevers caused by anger etc, should be cured by providing things/conditions which satisfy the sense organs, pleasing to the mind, mitigating the aggravated dosas and by explaining the suitability and insuitability of things (desired by the patient). Fever caused by anger gets relieved by fulfilling the desires, and that caused by desires gets relieved by anger; those born out of fear and grief get relieved by them (desire and anger in reverse order) and fevers due to others get relieved by fear and greif.

For fevers, caused by curse (of gods, ascetics etc.) and hymns of Atharvana (sorcery, witch craft etc.), daiva vyapasraya measures are the treatment.

Remembering the time of commencement of the fever should be vauquished by things pleasant to the mind (the patient should be made to forget the time of commencement of fever by diverting his attention).

Compassionate and pure (non-emotional, calm) mind cures all types of fevers. 168-173.

Apathya in jvara – unsuitable in fever

त्यजेदाबललाभाच्च व्यायामस्नानमैथुनम् । गुर्वसात्म्यविदाह्यन्नं यच्चान्यज्वरकारणम् ॥ १७४ ॥

Till the gaining of strength (the patient of fever) should avoid physical exercese, bath, sexual intercouse, foods which are heavy (not easily digestable), unaccustomed and which cause heartburn and all others (causes) which produce fevers.

न विज्वरोऽपि सहसा सर्वान्नीनो भवेत्तथा । निवृत्तोऽपि ज्वरः शीघ्रं व्यापादयति दुर्बलम् ॥ १७५ ॥

Though relieved of fever he should not begin to eat suddenly all types of food, for fever though relieved kills the weak patient soon. 175.

सद्यः प्राणहरो यस्मात्तस्मात्तस्य विशेषतः ।

तस्यां तस्यामवस्थायां तत्तत्कुर्याद्भिषग्जितम् ॥ १७६ ॥ Since the fever takes away life quickly, it should be treated at each stage suitably. 176.

Pathya – suitables

ओषधयो मणयश्च सुमन्त्राः साधुगुरुद्विजदैवतपूजाः । प्रीतिकरा मनसो विषयाश्च घ्नन्त्यपि विष्णुकृतं ज्वरमुग्रम् ॥ १७७ ॥

(wearing of) potent herbs and precious gems, (chanting) benovelent hymns, worship of saints, preceptors, the twice born (brahmanas) and gods, affectionate mind and (indulgence in ) objects, pleasing the mind cure dreadful fevers though caused even by Visnu ( Lord Almighty). 177.

इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां चतुर्थे चिकित्सितस्थाने ज्वरचिकित्सितं नाम प्रथमोऽध्यायः ॥ १ ॥

Thus ends the chapter Jvara chikitsa-the first in chikitsasthana of Astanga hrdaya samhita, composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.


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