Chapter XXXIX - Symptoms and Treatment of Fever (Jvara)

Now we shall discourse on the (symptoms and) medical treatment of Fever (Jvara-Pratishedha). 1.

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, Sushruta and others. “You have instructed us, O, you, the foremost of physicians, the subject on all the concomitant distressing symptoms (Upadrava) of Ulcer (Vrana). Now let us have a general outline and detailed description of the concomitant distressing symptoms, physiological and pathological conditions 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 Doshas 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.

Description of Jvara:—

To the query of the disciples, the divine physician, 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. 3.

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 Jvara (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 Doshas separately, or through that of any two of them in combination or through their cencerted action, or by any extraneous causes^[1] 4–5.

When the Doshas of the body are deranged by their respective aggravating causes and in the hours of their specific dominance^[2] they bring on an attack of fever by spreading through the whole organism. The deranged bodily Doshas augmented or enraged by their specific aggravating causes, enter into the Amashaya and soon find lodgment in the Rasa (lymph-chyle) by virtue of their inherent heat (Ushman). The Doshas thus deranged and mixed with Rasa obstruct the Rasa-carrying and sweat-carrying ducts, impair the digestive fire and expelthe inherent heat (Ushman) out of its seat in the Pakvashaya, and spreading all over the body during the period of their specific dominance, bring on fever and causes its rise and exhibit their specific colour on the skin, etc. (of the patient). 6–7.

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), over-fatigue, any process of physical waste, indigestion, introduction of 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 inaus picious stars or planets (at the time of birth), dynamics of deadly incantations or charms, curses (from Brahmanas 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 (Doshas) of the body being the existing origins of the disease. The stomachic heat is propelled by the extremely deranged and aggravated Doshas 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 perspiration. 8–9.

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 eyes, 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 Doshas is marked by the presence of all the symptoms, while, in the derangement of any two of these, the special symptoms of those two Doshas appear. 10.

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. 11.

Symptoms of Pittaja fever:—

High fever (hyperpyrexia), diarrhea, scanty but disturbed sleep, vomiting, inflamation in the throat, lips, mouth and nostrils, perspiration, delirious talks, swoon or fainting fits, burning sensation in the body, loss of consciousness, pungent taste in the mouth, yellowness of the stool, urine and of the eyes and vertigo are the symptoms which mark the Pittaja type of fever. 12.

Symptoms of the Kaphaja fever:—

Heaviness of the limbs, shivering, nausea, appearance of goose-flesh, excessive sleep, obstruction of the internal passages of the body, slight pain (in the limbs), water-brash, sweet taste in the mouth, slight heat in the body, vomiting, lassitude, mal-assimilation (Avi-pakata), whiteness (glossinss) of the eyes are the indications which point to the Kaphaja origin of the disease. 13.

Symptoms of the Tri-doshaja fever:—

Insomnia, vertigo, laboured or difficult breathing, drowsiness (somnolence), a sense of innertness 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 assimilation of the deranged bodily Doshas, (temporary) insanity, blackish yellow coat on the teeth, blackness and roughness of the tongue, pain in the head, in the joints and in the bone, dilation 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 fecal 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 Doshas of the body (Pridoshaja or Sannipataja) 14.

Abhinyasa fever:—

Now hear from me about the peculiar forms of this type of fever the symptoms whereof are as follows:—Where a 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^[3], aversion to 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 others call it a case of H at aujasa fever. 15.

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 Saunyasa when there is an innertness of the limbs. 16

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 Ojo-dhatu) by the experts. 17.

The disease, (in such cases) finds aggravation on the seventh, the tenth or on the twelfth day^[4] when the case takes either a favourable turn or ends in death. 18.

Symptoms of Dvandvaja fever:—

A case of fever which involves, and is due to the combined action of any two deranged Doshas of the body, is called Dvandvaja fever and such cases are classified into three different types (e.g. Vata-pitta-fever, Vata-shleshma-fever and Pitta-shleshma-fever). Yawning, distension of the abdomen, loss of consciousness, shivering pain in the joints, emaciation of the body, thirst, delirium 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 (Shula), cough, the vomiting of Kapha, shivering, coryza, cold, sense of heaviness of the limbs, aversion to food, and a feeling of general numbness, are the symptoms of a case of Vata-shleshma-fever (due to the action of the deranged Vayu and Kapha). 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-shleshma-fever (due to the action of the deranged Pitta and Kapha)^[5]. 19–21.

Even a small residue of the deranged bodily Doshas 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, is 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 locations of Kapha^[6]. These five types are known as the Satata, Anyedyushka, Tritiyaka, Caturthaka and the Pralepaka^[7]. The (residue of the) deranged Dosha 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 Amashaya (stomach) and thus brings on the virulent attack of (those) fevers. Of these the type known as the Pralepaka appears in cases of Shosha (consumption) and though its attak is a mild one, it puts almost insurmountable difficulties in the way of its cure, brings about a loss or waste of Dhatus (the seven fundamental principles of the organism) and thus ultimately ends in death. There are cases of Vishama-jvara known as the Viparyyaya type (reverse of the above type) which are the result of the deranged bodily Doshas being simultaneously located in two or four specific seats of the deranged bodily Kapha and are hard to cure. 22—23.

Several authorities hold Vishama Jvara to be sui-generis in its origin. But whether spontaneously 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 Vishama fever. The pre-dominance of the deranged and aggravated Vayu is marked in cases of Tritiyaka (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 Vishama fever ushered in by epileptic fits should be regarded as the result of the concerted action of any two deranged Doshas of the body. 24–25.

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 characteristic 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 Doshas 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. 26–28.

Fever of the Vishama 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 (Doshas) as mentioned before^[8] in the course of day and night. This Vishama 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 Vishama-jvara 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 patent only at the slightest exciting cause, just as a feeble fire fed with an insufficient supply of fuel, becomes patent at the slightest exciting cause. 29.

Seat of Vishama Jvara:—

Even a small residue of the deranged bodily Dosha, 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 invites a fresh attack^[9] which is known as the Vishama Jvara. A case of Santata (remittent or continuous) fever has its seat in the vitiated Rasa (serum) and blood^[10] of the organism; while a case of Anyedyuh finds location in the contaminated flesh of the body. The type known as the Tri-tiyaka (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 Vishama Jvara. 30.

Duration of Vishama Jvara:—

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 Anyedyushka type comes on only once a day and one of the Tri-tiyaka type comes on every third i.e., on every alternate day, while a case of Caturthaka fever sets in every fourth day. 31.

Influence of Vayu on Vishama Jvara:—

Just as the ocean is overflown when its water is swollen up by the gusts of wind (Vayu), so the bodily Doshas are aggravated by the bodily Vayu, and give rise to different kinds of fever. Just as the water of the occean floods the shore at flow-tide and rolls back to its former place during ebb-tide, so fever being augmented by the deranged Doshas 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 Doshas, only to be driven back into the deeper tissues and vital 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. 32.

Agantuka Jvara:—

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 Doshas 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, diarrhea, 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 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 a distracted state of the mind, drowsiness, languidness, aversion to food, pain at the cardiac 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 genii. 33–34.

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 attendant on the body. It exhibits all the symptoms characteristic of each of the deranged bodily Doshas involved therein^[11] 35–36.

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, laboured or painful breathing and cough. Paleness of the complexion, dulness of the sense-organs, emaciation of the body, depression of the mind^[12] and presence of supervening symptoms (e.g., hard breathing, cough, etc.) in cases of both Gambhira (inward or latent) and Tikshna (high) fever are the indications which point to the hopeless nature of the case. 37–38.

A slightly, middling or excessively aggravated condition of the deranged Doshas of the body forebodes the continuance 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. 39.

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 a case of the Kaphaja type under similar conditions. In cases of Dvi-doshaja and Tri-doshaja fevers, the foregoing measures should be adopted according to the Doshas 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. 40.

Fasting:—

The premonitory and the actual stages of fever are of various forms like those of fire and its fume. Fasting is pre-eminently 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 Dosha in the Amashaya (stomach) and attended with nausea, thirst, water-brash. Fasting should be continued as long as the least quantity of the deranged Dosha or Doshas would remain intact in the organism, and light food should then be given with discretion after the Doshas have been fully assimilated in (to) the sysmtem. 41.

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 Divi-vrana (Chapter I, 25—Chikitsa-sthana). 42.

Effect of Fasting:—

Fasting in the case of a patient in whom the bodily Doshas have been deranged and of whom the digestive fire has become dull, lead to an assimilation of the deranged Doshas and kindles the digestive fire, produces remission of fever, lightness of the body and relish for food. 43.

Satisfactory and excessive fasting:—

Easy and natural passing of Vayu and stool and urine, intolerable keenness of thirst and appetite, lightness of the body, sprightly, action of the mind and the sense-organs and a weakness of the body are the results which spring from Satifactory fasting; while such symptoms as loss of strength, thirst, dryness (of the mouth), insomnia, vertigo, doziness, fatigue and such other supervening symptoms (as difficult breathing, cough, fever, hic-cup) mark an excessive fasting. 44–45.

Tepid water:—

Tepid (boiled) water is appetising and it tends to disintegrate the accumulation of Kapha and restores the 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 Vayu, as it tends to cleanse the internal passages of the body and helps in the easy movement of the deranged bodily Doshas in the organism. The effect of cold water is just the reverse and its inherent cold tends to aggravate fever. 46

Peya:—

A potion consisting of water boiled with the admixture of the following bitter drugs viz. Gangeya (Musta), Nagara, Ushira, 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 of any liquor or poison^[13]. 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 Dosha 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. 47–49.

A decoction of Panca-mula assimilates the bodily Dosha in a case of Vataja fever, while a decoction of Musta, Katuka and Indra-yava mixed with honey (when cold) proves curative in a case of Pittaja fever, and a decoction of the component drugs of the Pippalyadi group helps the assimilation of the deranged bodily Dosha in a case of Kaphaja fever. Decoctions remedial to each of the deranged bodily Doshas should be administered in combination in a case of fever due to the concerted action of any two deranged Doshas 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 weak' ness, emaciation and indigestion. 50.

Symptoms of Pakva-jvara:—

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 Doshas should be presumed, and it is then that febrifuges should be administered according to the nature of the deranged bodily Doshas underlying the case under treatment^[14]. Some, however, believe that the assimilation of the deranged Doshas should be presumed from the changes in the symptoms characteristic of the Doshas. 51.

Symptoms of Ama-jvara:—

A crushing sensation in the region of the heart, drowsiness, salivation, aversion to food, non-assimilation of the deranged bodily Doshas, suppression of stool (and wind), copious discharge of urine, laziness, sense of heaviness in the abdomen, stoppage of perspiration, undigested stool, dissatisfaction, somnolence, heaviness and numbness of the limbs, dulness of appetite, 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 Doshas usheringin an attack of fever. 52.

Time for administering Febrifuge:—

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 Doshas 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 a case of fever with undigested Dosha) helps the lapse of the disease (fever) into a Vishama type. 53–54.

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:—

A suitable purgative should be administered even in a case of acute fever if the digested Malas (fecal matter etc.) are accumulated in the internal passages of the Koshtha (abdomen), in as much as their presence in the organism in that undigested state may usher in an attack of Vishama Jvara attended by distressing symptoms, or may produce loss of strength. Hence they should be eliminated from the system with the helf of emetics, etc. Emetics, Asthapana-enemas, purgatives, Shiro-virecana and errhines should be successfully employed for the purpose. Emetics should be at the outset exhibited in a case of Kaphaja fever where the patient would be found to be a person of considerable physical strength, and purgatives 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). Nirudha-vasti 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-vasti should be prescribed for a patient with a strong appetite, if there be pain in the regions of the back and the waist. Shiro- virecana (head-purgative) should be adiministered in cases marked by the accumulation of the deranged Kapha in the head, as the pain in and heaviness of the head would be relieved, and the sense-organs roused up thereby to their normal functions. 56-A.

A plaster composed of Deva-daru, Vaca, Kushtha, Shatahva, Hingu and Saindhava pasted together with Kanjika should be applied lukewarm to the abdomen in a case of fever attended with painful tympanites 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, Yamani and Cavya should be given to the patient as a potion, it being remedial for the deranged bodily Vayu, 56.

Administration of Ghrita:—

The residue of the deranged bodily Dosha 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 clarified butter, if the system of the patient be sufficiently dry (Ruksha). 57.

A weak patient with only a small quantity of the deranged bodily Dosha should be treated with the help of soothing (Shamaniya) 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. 58.

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 vomiting, thirst, burning or perspiration and it should be followed, when duly digested, by meals of rice-soup and meat-soup. 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 type^[15] 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 it 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-shleshma 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. 59–60.

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., boiled 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. 61–62.

Prepared barley mixed with any old wine would prove beneficial in cases of (fever accompained by) a dullness of appetite. Takra (butter-milk 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. 63-A.

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 Dosha in the system, by emaciation of the frame and by mental depression as well as in a case of V ata-pittaja fever accompained by dryness of the organism and nonemission or otherwise of the deranged bodily Doshas 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. 63.

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 the 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). 64–66.

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 Satataka or Vishama fever. The soup of such pulses as Mudga, Masura, Chanaka (gram), Kulattha and Makushtaka, etc. may be given with benefit as diet to the hungry patient suffering from fever. 67. A

Meat-diet:—

The meat of Lava, Kapinjala, Ena, Prishata, Sharabha, Kala-puccha, Kuranga, Mriga-matrika (different kinds of deer) or Shasha (hare) may be prescribed as diet for a fever-patient accustomed to the use of animal food^[16]. Several authorities, however,^[17] do not recommend the use of the meat of Sarasa, Krauncha, Mayura (peacock), Kukkuta (cock) and of Tittira in cases 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. 67.

Prohibitions in fever:—

A fever-patient should forego baths, washing (Parisheka), 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.^[18] 68.

Any of the preceding prejudicial acts done in a weak state of health, closely following a recovery from fever may bring on a relapse which invariably 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. 69.

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 (Shodhana) remedy should be resorted to even after the subsidence of fever in the case where the continuance of a residue of the deranged Doshas in the organism would be 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. 70–72.

All cases of fever should be remedied with therapeutic agents antidotal to the exciting factors. The principal pathogenic cause or causes should be first removed and remedied in a case of fever due to bodily exhaustion, waste or hurt. An attack of (peurperal) 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 Dosha-subduing (Samshamana) remedies according to the deranged bodily Dosha involved therein. Now we shall deal with the recipes of Dosha-subduing (Samshamana) decoctions which may be advantageously employed in all types of fever. 73–74.

Samshamana decoctions for Vata- Jvara:—

A decoction duly prepared of Pippali, Sariva, Draksha, Shatapushpa and Harcnu should be given with the admixture of treacle in a case of Vataja fever or a cold infusion^[19] of Guduci should be taken by the patient. Similarly a decoction of Vala, Darbha and Shva-danshtra boiled down to a quarter part of the original quantity of water and mixed with sugar and clarified butter; or a decoction of Shatapushpa, Vaca, Kushtha, Devadaru, Harmuka, Kustumburu Nalada and Musta mixed with sugar and honey should be given to a patient in a case of Vataja fever. A decoction of Draksha, Guduci, Kashmarya, 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 Shatavari 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. 75–81.

Samshamana decoctions for Pittaja Jvara:—

A decoction of Shriparni, red sandal wood, Ushira, Parushaka and Madhuka (Moul) flowers duly boiled and mixed with a proportionate quantity of sugar (when cold), or a decoction of the drugs of the Sarivadi group duly mixed with sugar, or a decoction of the drugs of the Utpaladi group and Yashti-madhu,^[20] 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. 82–84.

A decoction of Draksha and Aragvadha, or of Kashmarya, or of the drugs of sweet, bitter or astringent groups mixed with sugar and used, when cold, would alleviate thirst and the severe burning sensation of the body (in a 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 Kshiri-Vriksha (milk-exuding trees), or with Chandana 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. 85—87.

Draughts of water with Padmaka, Yashti-madhu, Draksha, Paundarika (white lily), Utpala, parched barley, Ushira, Sarnanga and Kashmari fruit steeped therein 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 (Keshara) of Matulunga mixed with honey and Saindhava salt, or of Dadima mixed with sugar, Draksha 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. 88–89.

Samshamana decoctions for Kaphaja Jvara:—

A decoction of Saptacchada, Guduci, Nimba and Sphurjaka mixed with honey, or of Tri-katu, Naga-Keshara, Haridra, Katurohini and Indra-yava, or of Citraka, Haridra, Nimba, Ushira, Ativisha, Vaca, Kushtha, 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, Ativisha, Kushtha, Puru (Guggulu), Duralabha and Musta, or of Musta, Vrikshaka-seeds (Indra-yava), Tri-phala, Katurohini and Parushaka will be found to be equally efficacious in the case of Kaphaja fever. 90–94.

Treatment of Kapha-Vataja Jvara:—

A decoction of the component members of the Raja-vrikshadi 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 exhibition of the decoction of Nagara, Dhanyaka, Bhargi, Abhaya, Devadaru Vaca, Parpataka, Musta, Bhutika, and Katphala mixed with honey and Hingu (asafetida) 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. 95–96.

Pitta-Shleshmaja Jvara:—

A decoction duly prepared with Ela, Patola, Tri-phala, Yashtyahva, and Vrisha (Vasaka) and mixed with honey, or one of Katuka, Vijaya, (Haritaki), Draksha, Musta and Parpataka, or of Bhargi, Vaca, Parpataka, Dhanyaka, Hingu, Abhaya, Ghana, Nagara and Kashmarya mixed with honey would prove efficacious in a case of fever due to the combined action of the deranged Pitta and Shleshma. Similarly two Tola-measure of powdered Katuka and sugar dissolved in warm water proves curative equally in a case of the present type. 97–100.

A decoction of Bhu-nimba, Guduci, Draksha, Amalaki and Shathi mixed with treacle, or of Rasna, Vrisha (Vasaka), Tri-phala and fruits of Raja-vriksha proves curative in a case of fever due to the combined action of the deranged Vayu and Pitta 101–102.

Drugs and therapeutic agents remedial to each of the specific deranged Doshas involved in a case of the Tri-doshaja type should be employed in combination for cure according to the predominance of each Dosha. A potion of milk duly boiled with Vrishckika (white Punarnava), Varshabhu (red Punarnava), Vilva and water, but from which the water has entirely evaporated would prove curative in Tri-doshaja fever. The pith and marrow of a Shirisha 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 Tri-doshaja fever. A potion of the decoction^[21] duly prepared with the roots of

Nala and of Vetasa (cane) and Murva and Devadaru would prove remedial to this form of fever.^[22] Clarified butter mixed with the decoction of Tri-phala should be given to a patient suffering from an attack of Tri-doshaja fever.^[23] 103–106.

Two-Tola-measure of powdered Ananta (Duralabha), Valaka, Musta, Shunthi and Katuka should be given with (one Pala of) tepid water with benefit to a patient before sun-rise in Tridoshaja 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-doshaja fever. Trivrit with honey would pacify a case of high fever. 107–109.

Medical treatment of Vishama-Jvara:—

Purgatives and emetics should be exhibited in a case of Vishama Jvara and the medicated clarified butter described under the treatment of Plihodara (chapter XIV Chikitsa-sthana), or pulverised Tri-phala^[24] with the addition of treacle may be advantageously used in the type under discussion. A decoction of Guduci, Nimba^[25] and Dhatri duly mixed with honey, may be likewise prescribed (in a case of Caturthaka fever). The patient should be likewise made to take Lashuna (garlic) with clarified butter. The three decoctions duly prepared with three, four or all of the following drugs, viz:—Madhuka, Patola, Katuka, Mustaka (D. R.—Batsaka) and Haritaki^[26] should be likewise administered. 110–111.

A potion consisting of milk, clarified butter, sugar, honey and Pippali should be administered according to the strength of the patient. Similarly Pippali should be taken with the decoction of Dasha-mula. Pippali-Bardhamana (see chapter V, Chikitsita-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 fowl is also recommended. 112

Use of medicated Ghrita in cases of Vishama Jvara:—

Clarified butter duly cooked with the decoction of Kola,^[27] Agnimantha and Tri-phala, with milk-curd (Dadhi), with Tilvaka as Kalka would be found to be highly efficacious in a case of Vishama Jvara. A potion of clarified butter duly cooked with the Kalka (and decoction—Dallana) of Pippali, Ativisha, Draksha, Sariva, Vilva, Chandana (red), Katuka, Indra-yava, Ushira, Simhi, Tamalaki, Musta, Trayamana, Sthira (Shala-parni), Amlaki, Shunthi and Citraka would be found highly beneficial to irregular (Vishama) 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. 113–114

Guducyadi 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 Draksha, Magadhika, (Pippali), Ambhoda (Musta), Nagara, Utpala and Chandana would be attended by good results in cases of consumption, asthma, cough and Jirna-Jvara (chronic fever). 115.

Kalashyadi Ghrita:—

Cases of chronic fever 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 Kalashi (Prishni-parni), Vrihati, Draksha, Tryanti, Nimba, Gokshura, Vala, Parpataka, Musta, Shala-parni and Yavasaka and with the Kalka of Shathi, Tamalaki, Bhargi, Meda, Kataka (D. R.—Amalaka) and Pushkara-roots and with milk twice as much as the clarified butter. 116.

Patoladi Ghrita:—

Clarified butter duly cooked with the Kalka of Patola, Parpata, Arishta (Nimba), Guduci, Tri-phala, Brisha, Katuka, Ambuda (Musta), Bhunimba, Yavasa, Yashti-madhu, Chandana, Darvi, lndra-yava, Ushira, Trayamana, Kana and Utpala and with the expressed juice of Dhatri, Bhringa-raja, Abhiru (Shatavari) and Kaka-machi readily proves curative in cases of Apachi (scrofula), Kushtha, fever, Shukra and Arjuna (two optical diseases), ulcer and in diseases of the mouth, ears, nose and the eyes. 117.

Kalyanaka Ghrita:—

Clarified butter duly cooked with the Kalka of Vidanga, Triphdla, Musta, Manjishtha, Dadima, Utpala, Priyangu, Ela, Elavaluka, Chandana, Devadaru, Varhistha (Valaka), Kushtha, Haridra, the two kinds of Parnni and of Sariva, Harenuka, Trivrit, Danti, Vaca, Talisha, Keshara 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 Vishama Jvara, 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. 118.

Maha-Kalyanaka Ghrita:—

A Prastha measure of clarified 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 Sarva-gandha (Eladi-gana) and with (dead) gold and gems should again be duly cooked with the Kalka of Sumanah, Champaka, Ashoka and Shirisha 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 aud 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. 119.

Panca-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, the two kinds of Haridra, Ativisha, Vaca, Vidanga, Tri-katu. Cavya and Suradaru prove curative in Vishama Jvara. It is called Panca-Gavya-Ghrita. The same five 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 or of Vala, or of Guduci.^[28] All of these medicated Ghritas are efficacious in cases of Jirna Jvara (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-buffalo 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. 120–122.

Tri-phaladi Ghrita:—

Clarified butter duly cooked with the Kalkas^[29] of Tri-phala, Ushira, Sampaka, Katuka, Ativisha, Shatavari, Sapta-parna, Guduci, the two kinds of Rajani, Citraka, Trivrita, Murva, Patola, Arishta, Valaka, Kirata-tikta, Vaca, Vishala, Padmaka, Utpala, the two Kinds of Sariva, Yashti-madhu, Cavika, Rakta-chandana, Duralabha, Parpataka, Trayamana, Atarushaka (Vasaka), Rasna, Kumkuma (saffron), Manjishtha, Magadhi and Nagara with the expressed juice of Dhatri weighing twice as much as clarified butter proves curative in Parisarpa (erysipelas), fever, Asthma, Gulma, Kushtha, Chlorosis, enlargement of the spleen and dulness of appetite. 123.

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.^[30] 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). 124.

Panca-shara:—

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 Vishama-Jvara, Kshata-Kshina, consumption, asthma and affections of the heart. 125.

Medicated Tailas:—

A medicated oil duly prepared by cooking it with Laksha, Vishva, Nisha, Murva, Manjishtha, Sarjika and Amaya (Kushtha) as Kalka and with Takra weighing six times as much as oil acts as a febrifuge. A medicated oil duly cooked and prepared with Kshiri-Vriksha, Asana, Arishta, Jambu, Sapta-cchada, Arjuna, Shirisha, Khadira, Asphota, Amrita-valli, Atarushaka, Katuka, Parpata, Ushira, Vaca, Tejovati and Ghana as Kalka may be employed in anointing the body of the patient in a case of Jirna-Jvara with benefit. 126–127.

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 Nirudha-Vasti application on the date of the expected attack. 128.

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, Kushtha, Palankasha (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-shila) should be pasted together and mixed with oil and be applied along the eye-lids as an Anjana. 129–130.

The medicated Ghritas mentioned in conection with the treatment of Udara (ascites), as well as the Ajita Ghrita mentioned in the Kalpa-sthana (Chapter II.) may be likewise employed with benefit in fever. 131.

A case of fever due to the malignant influence of the spirits, etc. should be remedied with the help of magical incantations (Aveshana), 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^[31] 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 (Ushna) 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 Dosha 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 of any sort of poison, the treatment should consist in such measures as would alleviate the poison and the aggravated Pitta in the system.^[32] Decoction of Sarva-gandha (the drugs of the Eladi-gana) is also beneficial in these cases. A decoction of Nimba and Deva-daru or of Jati flowers may be prescribed as well. Clarified butter, wine and preparations of barley grains are wholesome in a case of Vishama-Jvara which may be got rid of as well by worshipping Brahmans, cows, the god Ishana, and Ambika. 132–133.

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^[33] and heating measures should then be resorted to. In the alternative, a compound of Aranala, Shukta, cow’s urine and Mastu (curd-cream) made lukewarm should be sprinkled over the body. Plasters of the leaves of Surasa, Arjaka and Shigru pasted together with water would prove beneficial. The body may be rubbed with Kshara-taila (oil cooked with alkali) mixed with Shukta. 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. 134-A.

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 down from their slender waists, with their splendid buttocks naturally making them lazy in their steps, with their lips vying with the ripe Vimba fruit in their luscious redness, with their elevated thickest 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 girls 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 damsels should be treated to such a wholesome repast as would be welcome to him. 134.

Measures which alleviate the burning sensation should be employed in a case of fever marked by sever burning sensation of the body. Vomiting should be induced in such cases with honey and treacle mixed with the (cold) infusion of Nimba leaves. The body of the patient should be anointed with Shata-dhauta^[34] Ghrita and then plastered with a paste formed by mixing powders of barley, Kola and Amalaka with the fermented boilings of Shuka 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 of the leaves of Palasha pasted with Amla (Kanjika, or with the froth (produced by stirring in Kanjika the paste) of the leaves of Vadara or Arishta,^[35] whereby thirst, swoon and burning sensation would be relieved and removed. 135.

A Prastha measure of oil duly prepared by cooking it with half a Kudava measure of Yava (barley), half a Pala weight of Manjishtha 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. 136.

In the alternative, the body of the patient should be plastered with the pasted drugs of the Nyagrodhadi, Kakolyadi or Utpaladi groups, 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 Shita-kasaya^[36] 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 youthful 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. 137.

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 Doshas of the body, in as much as it is extremely 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 principal disease (fever) but are antidotal to the exciting factors. 138.

Specific treatment of the complications:—

Now hear me tell you other specific remedies for the complications. A plaster composed of Yashti-madhu, Rajani, Musta, Dadima, Amla-vetasa, Rasanjana, Tintidika (tamarind), Nalada (Mansi), Patra, Utpala, Tvak (cinnamon), Vyaghra-nakha, the expressed juice of Matulunga, honey and Madhu-shukta,^[37] if applied to the head, would alleviate heat in the 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, Hrivera, 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, Rakta-pitta (hemoptisis) and asthma. Fits of cough and asthma in cases of fever readily yield to the use of the electuary prepared with Tri-phala, Pippali and Makshika^[38] and mixed with honey and clarified butter. 139–141.

A plaster of Vidari, Dadima, Lodhra, Dadhittha and Vijapuraka pasted together may be applied with advantage to the scalf of a fever-patient afflicted with thirst and burning sensation. Pastes of Dadima and sugar, and of Draksha and Amalaka, if kept in the mouth, or a gargle (Gandusha) of milk, expressed juice of sugar-cane, Madhvika,^[39] 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 Jivaniya group. 142–144.

A pulverised compound consisting of Tri-phala, Shyama, Trivrit and Pippali mixed with honey and sugar, can be given for purgative purposes with benefit after the digestion of the deranged Dosha 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 Dosha. 145.

Application of Vastis:—

Nirudha-vastis 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 Dosha in the case and to the strength of the patient; in the alternative, Anuvasana Vasti should also be similarly applied. The decoction of the drugs of the Utpaladi group mixed with Chandana and Ushira and sweetened with the addition of sugar should be similarly applied cold (as a Nirudha Vasti) in cases of Pittaja fever. A Vasti (in the manner of Nirudha) charged with a compound consisting of Amra- barks, etc., Shamkha (conch), Chandana, Utpala, Gai?ika, Rasanjana, Manjishtha, Mrinala and Padma-kashtha 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 Vasti charged with a decoction of the preceding drugs in the manner of an Anuvasana-vasti. A Nirudha Vasti charged with the decoction of the drugs of the Aragvadhadi group mixed with (the powders of) the drugs of the Pippaladi group and with honey should be applied in cases of Kaphaja fever and the decoction of the Kapha-subduing (Aragvadhadi) drugs should also be injected into the rectum in the manner of an Anuvasana Vasti. In cases of fever due to the aggravation of two or three Doshas, the Vastis (Nirudha and Anuvasana) to be applied should be charged with the decoction of the drugs respectively antidotal to the deranged Doshas involved in each case. 146–150.

All the medicated lardacious substances with the exception of oil, which have been prescribed as being efficacious (in the use of Vastis) in diseases of the deranged Vayu, are equally applicable (in Anuvasana Vastis) 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 beneficial results in a case of Vata-shleshma 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 bitter and pungent drugs. In the cases of fever due to the concerted action of two or three Doshas, the Ghrita should be cooked with the drugs of two or more of the above groups according to the nature of the Doshas involved in each case. 151–152.

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 or Sarvats (sugar dissolved in water), and the diet in such a case should consist of cooked Shali and Shashti rice and milk. Fomentations and anointments should be employed in cases of Kaphaja and Vataja fevers. Draughts of clarified butter should be given in all forms of fever at the close of twelve days, for by that time the aggravated Doshas return to their respective Ashayas (places in the system). The Dosha 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. 153–155.

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. 156.

Fever originating from the wrath-fire of the god Shambhu, is a dangerous disease. It affects 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 the organism (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. 157.

 

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

Footnotes and references:

[1]:

There can be three cases of fever due to the derangement of the three Doshas separately, three cases from the derangement of two of them at a time and one case only from the concerted action of the three Doshas 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 Vāyu, in the evening. Fever follows a distinct periodicity determined by the time of aggravation of the deranged bodily Doshas ushering in the attack An attack of fever due to the deranged Kapha comes on in the morning or after dusk; one due to the deranged Pitta comes on at noon or midnight, one due to the deranged Vayu comes on in the afternoon or during the small hours of the night. In a case of Dvi-doshaja 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 Dosha and continues through those peculiar to each of them. All night attacks should be regarded as connected with the action of the deranged Pitta. In a Tri-doshaja 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. Vāyu is aggravated in the Varshā (rainy) season, Pitta, in the Śarat (autumn) and Kapha, in the Vasanta (spring).

[3]:

“sāśrunirbhugnanayanaḥ” is different reading in place of “sāsro nirbhugnahṛdayaḥ” | The term “nirbhugna” is more appropriately applicable to “nathana” than to “hṛdaya” both grammatically and in sense.

[4]:

The fever in which Vāyu predominates gets aggravated on the 7th, that in which Pitta predominates becomes aggravated on the 10th and that in which Kapha predominates comes to be aggravated on the 12th day. According to some authority, however, Abhinyāsa, Hataujasa, and Sannyāsa types of fever are pacified on the 7th, 10th and 12th. day respectively. —Dallana.

[5]:

Dallana in his commentary has quoted in eight lines with different wordings the symptoms of these kinds of Dvandvaja fever and these lines have been adopted by Mādhava in his Nidāna The lines when translated would be thus:—Thirst, unconsciousness, vertigo, burning sensation, 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 Vāta-pitta-fever. Sensation of moisture (stimita) 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 Vāta-śleshma-fever. A bitter taste, a coaling on the mouth, somnolence, unconsciousness, cough, disrelish for food, thirst, alternate and varying sensation of heat and cold are the symptoms of Śleshma-pitta-fever.

[6]:

The five locations of Kapha are the Āmāśaya, chest, throat, head and the joints.

[7]:

There is another kind of Vishama Jvara named Santata (cf. Śloka 31 of this Chapter) and Dallana remarks that it is begotten when the residue of the deranged Dosha is lodged in all the five seats of Kapha.

[8]:

See chapter XXI.—Sutra-sthāna.

[9]:

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

[10]:

Vijaya Rakshita, the commentator on Mādhava Nidāna, says, on the authority of Charak, that by the term Santata are meant here both Santata and Satataka and that they have their origin in the vitiated Rasa and blood respectively.

[11]:

“Abhicār,” means incantations or Atharvan rites by which disease, death and any other injuries are brought about.

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

[12]:

Dallana 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.

[13]:

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

[14]:

Some read these two lines in a different way. They would mean that the non-assimilation (Āma) of the deranged Doshas would be presumed by the presence of high fever, heaviness of the body and stoppage of the excreta (Mala), and the reverse is the sign of their assimilation (Pāka).

[15]:

This passage is quoted by Śrīkantha Datta in his commentary on Chakra-datta wherein he does not read “kṣīṇe” (mild type), and his read ing appears to be the better one, it being supported by Charaka as well.

[16]:

According to Charaka, the meat-soup, in cases of fever, may be given with or without the addition of an acid juice (e.g. Dādima, Āmlaki, etc)

[17]:

Charaka also holds the same opinion as Suśruta.

[18]:

Additionnal 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 evidently Dallana’s reading.

[19]:

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

[20]:

Yashti-madhu is comprised in the drugs of the Utpalādi group. Hence in preparation of this decoction, two parts of Yashti-madhu should be taken.

[21]:

The decoction should be prepared with water only or with milk and water according to the rules of Kshira-pāka, if the exigencies of the case so require—Dallana.

[22]:

Additional text:—A potion of the decoction of Haridrā, Bhadra-musta, Tri-phalā, Katuka, Nimba, Palola, Devadāru and Kanta-kāri would cure a case of Tri-doshaja fever with indigestion, water-brash, dropsy, cough and disrelish for food.

[23]:

Dallana includes this line also in the additional text.

[24]:

According to Dallana the decoction of Tri-phalā should be used.

[25]:

Chakradatta reads “Musta” in place of “Nimba”.

[26]:

Dallana says that some commentators are inclined to use the decoction of the 16 different combinations of the five drugs taken three, four or five at a time.

[27]:

Kola is here used for Panca-kola, viz:—Pippali, Pippali-roots, Cavya, Citraka and Nāgara.

[28]:

Dallana says that the expressed juice of Vāsaka, Balā or Guduci, should be separately used along with the ordinary Kalkas (Tri-phalā, etc.) of the Panca-gavya Ghrita. But we are inclined to take the lines to mean that Vāsaka, Valā and Guduci should be separately used as Kalkas in place of the ordinary Kalkas.

[29]:

Some here add Ghana (Musta) with the other Kalkas.

[30]:

Additional text:—Some recommend the use of Kutaja, Bhunimba, Ghana (Musta), Yashti-madhu, Chandana and Pippali as Kalka in the preparation of this Ghrita and that it 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.

[31]:

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.

[32]:

In place of “viṣapittaprasādanaiḥ” some read “viṣapītaprasādanaiḥ” and that would mean that the measures and remedies prescribed in cases of poisoning (sec Kalpa-sthāna) should be applied. This variant seems to be the better one.

[33]:

Dallana explains the Ushna-varga (heat-making group) to mean the Bhadra-dārvādi, Surasādi and the Elādi groups.

[34]:

Clarified butter washed hundred times in water is known as Śata-dhauta Ghrita.

[35]:

Arishta according to Dallana and Śrikantha (the commentator of Vrinda) may mean either Nimba or Phenilā (soap-b?rry). But Śivadāsa, the commentator of Chakradatta, explains Arishta to mean (leaves of) Nimba. The practice, however, is, to use the leaves of Nimba.

[36]:

“Śita-kasāya” may here mean either the Cold infusion of the drugs or only the cold decoction.

[37]:

Madhu-śukta is prepared by preserving the expressed 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. (Dallana) For an alternative mode of preparation see ‘śāṅgadhara”, Chapter X—“mathya khaṇḍa”.

[38]:

Dallana takes “Mākshika” in the sense of honey and comments largely on the seperate use of honey in the compound. But we are inclined to take “Mākshika” as the mineral of the same name.

[39]:

Dallana seems to read “Mākshika.” and explains it as honey. “Madhvika” which generally means the wine made of honey, may however, also mean honey.