Chapter CXLVII - The Nidanam of Fever

Dhanvantari said:—Now I shall describe the Nidanam of fever, with the help of which a fever of whatsoever type may be correctly diagnosed. The terms, the lord of diseases, the sinful one, the lord of death, the devourer, and the finisher are the synonyms of fever. Sprung from the upper eye of the wrathful and insulted Rudra in the sacrifice which was celebrated by Daksha, this dreadful and sinful disease attacks all species of animals, through their injudicious conduct. Unconsciousness heat and delirium being its principal characteristics. Manifest in the body of an elephant, it is called Pakala. The type of fever which is peculiar to the horse, is called Abhitapa, In dogs, it is called Alarka; in clouds, it is called Indramada; in water, Nilika; in cereals, Oshadhi; in soil, Ushara.

The type due to the action of the deranged Kapham, is marked by nausea, vomiting., cough, numbness of the body, coldness of the skin, and appearance of rashes or eruptions on the body. As birth, growth, and death are natural to all created beings, so aggravation and amelioration are natural to all types of fever. Indigestion with a non-relish for food, numbness of the body, lassitude, a burning sensation in the region of the heart, restlessness (the patient finding no relief in any position whatsoever), non-evacuation of stool and other deranged principles, salivation, nausea, loss of appetite, tasteful moisture in the mouth, heat and gloss of the skin, heaviness of the body, constant urination, and natural fulness of the body, are the symptoms, which mark the type known as ama-Jvara, (i.e., the stage in which the deranged humours have not been digested or resolved). Rousing of the appetite, lightness of the limbs, abatement of the bodily temperature, and evacuation of the contents of the bowels after the eighth day of the attack, are the indications, which show that the deranged humours have been digested or have undergone resolution. Symptoms, which are peculiar to the several deranged humours combinedly mark the type of fever which is the product of their concerted action. Headache, swooning, vomiting with a burning sensation in the body and parchedness of the throat, aching pain in the joints, insomnia, fright, horrification, yawning and delirium, are the symptoms which characterise the type of fever due to the combined action of the deranged Vayu (nerve-force) and Pittam (metabolism). Small heat, with a non-relish for food, pain in the joints and headache, low breathing, cough, and discolouring of the skin are the indications of the type due to the combined action of the deranged Vayu and Shleshma (Kapham). Fitful shivering, numbness of the body, perspiraton with a burning sensation of the body, thirst, restlessness, vomiting of mucous and bilious matter, stupefaction, drowsiness, clamminess and a bitter taste in the mouth, are the indications of the type due to the combined action of the deranged Pittam and Kapham. All the symptoms combinedly mark the type which is due to the concerted action of the deranged Vayu, Pittam, and Kapham in addition to the following specific ones, viz., alternate fits of shivering and burning sensation in the body, vertigo, sleepy in the day, sleeplessness in the night, constant sleepiness or complete insomnia, excess or absence of perspiration, singing, dancing, laughing, stoppage of the natural functions of the organs, with sunk, redshot, watery eyes, and drooping eyelids, accumulation of grity wax at the corner of the eyes, pain at the head, sides, joints and calves of the legs, vertigo, ringing in the ears, pain, violent shivering or absence of shivering, sooty colour of the tongue which becomes as black as charcoal and rough as that of a cow, heaviness and looseness of the joints, vomiting of bloody or blood-streaked bile, rolling or tossing about of the head, violent unquenchable thirst, eruptions of warts or circular rushes on the skin, pain at the heart, purging or scanty evacuations of stool, glossiness of the face, prostration of strength, loss of voice, delirium,, deep heavy somnolence, and a croaking or wheezing sound in the throat. The type which is marked by the foregoing symptoms is called Abhinyasa Sannipata. It destroys the principle of Ojas in the body (protoplasmic cells). In the Sannipatika type of fever, the deranged Vayu produces the constriction of the throat, and the deranged Pittam consumes the vital principle of the organism. The deranged Pittam, on account of its, expansive character, finds an outlet through, and tinges the conjunctiva with its own characteristic colour (yellow). Hence the yellowness of the eyes in a case of Sannipatika fever. A case of Sannipatika fever in which the deranged Vayu, Pittam and Kapham, being extremely aggravated, impair the digestive heat and thereby help the full development of all its characteristic symptoms, proves incurable. In ail other events, a Sannipatika fever can be made amenable to medicine only with the greatest difficulty. There is a different type of Sannipatika fever in which the deranged Pittam, separately enraged and aggravated, gives rise to a burning sensation in the skin and the stomach (lit.,. the abdominal cavity), the burning sensation coming on either with the commencement or with the abatement of the paroxysm, and being first experienced either in the stomach or in the skin. Similarly, the aggravated Vayu and Kapham produce rigor in Sannipatika fever, which being preceded by a burning sensation in the body indicates an unfavourable prognosis and is more dangerous of the said two types. In a case of Sannipatika fever in which the rigor comes on first owing to the action of the deranged and aggravated Pittam, the Kapham is set free and corrected, and with the abatement of the action of the aggravated Pittam comes on fainting, with swooning, vertigo, and thirst, etc. Somnolence, langour and vomiting manifest themselves in succession at the close of the paroxysm, which is ushered in with a shivering sensation. Fevers caused by the effects of a hurt or a blow, or contracted through any foul contagion, or engendered through the potency of any spell¹, magic, or incantation, as well as those which are due to burns or scalds, are usually grouped under the traumatic head of fevers and owe their origin to extrinsic causes. Extreme fatigue or exhaustion brings on a type of fever in which the enraged and aggravated Vayu affects the vascular process of the organism, and produces pain, swelling and discolouring of the skin. Anger, fright,, bereavement, passion of love, exhalations of poisonous drugs, dusts of flowers, narcotics and the baneful influence cast by malignant planets may engender types of fever, which may' be grouped under the traumatic head, and in which the patient laughs, weeps- or raves like a maniac in succession. The type of fever caused by the odours or exhalations of any drug or cereal is marked by headache, vomiting, epileptic fits and wasting, etc., while the one, due to the effects of any poison, develops dysentery, epilepetic fits, vertigo with a yellowish black clour of the skin, and a burning sensation in. the body.

Palsy and pain in the head are the symptoms, which-mark the case of fever due to anger, while delirium and palsy characterise the one due to the conjoint effects of fright and rage. Fever, which has its origin in the ungratifìed Sexual desire, develops such symptoms as loss of consciousness or absent-mindedness, with somnolence, impatience, shyness, and a non-relish for food'. In fever due either to the influence of malignant stars, or to the concerted action of the three morbific principles of Vayu, Pittam and Kapham (Sannipata) both the Vayu and the Pittam of the organism are simultaneously enraged. The types of Sannipatika fever caused through the dynamics of a curse or an incantation, are simply unbearable in their intensity. Incases of spell-origined fever the patient should be basked in the glare of the sacrificial fire (Homagni) into which libations of clarified butter should be cast by reciting the Abhichara-Mantram. The two last named types of fever are usually ushered in by the appearance of a large crop of bilious eruptions on the skin, great restlessness, fainting fits, and the absence of any distinctive knowledge regarding the different quarters of the heaven. The patient tosses about in the bed in intense agony, and the heat goes on increasing day after day. Thus the premonitory symptoms of the eight forms of fever have been briefly described.

All types of fever are either mental or physical, superficial or affecting the deeper principles of the organism, and mild or virulent. Similarly they may be grouped under two broad sub-divisions such as mature or immature, and Epidemic or sporadic.^[1]

A paroxysm of bodily fever first affects the body, whereas it first invades the mind in a case of the mental type. In cases of fever due to the action of the deranged Kapham (cold or catarrhal fever), the deranged Vayu, in conjunction with the deranged Kapham, produces rigor and horripilation, whereas the combination of the deranged Pittam in such cases is witnessed as the burning sensation in the body.

Contrary symptoms such as hyperperaxia with loose motions of the bowels are manifest in a case of Sannipatika fever only on account of the simultaneous derangement of the different morbific principles of the body of a contrary character. In cases of Vahirlinga Sannipata all the symptoms are restricted to the external or superficial principles of the organism, and therefore they become fully patent.

The organic Vayu becomes deranged during the rainy season (Bhadra and ashvin), the Pittam in autumn (Karticka and Agrahayana), and Kapham in spring (Phalguna and Chaitra)^[2] Hence a case of fever which is due to the deranged Vayu is said to be natural when it breaks out in the rainy season. Similarly, cases of Pittaja or Kaphaja fever breaking out in autum or spring are said to be natural. In fever due to the action of the deranged Pittam and which breaks out in autum, the Kapham lies subservient to the deranged Pittam. Accordingly the patient may be safely advised to fast in the case of fever which is due to the concerted action of the deranged Pittam and Kapham. In spring, the deranged and aggravated Kapham, in conjunction with the deranged Vayu and Pittam, gives rise to a type of fever in which the two last named morbific principles of the body remain subordinate to the enraged Kapham.

A paroxysm of fever unattented with any supervening or dreadful symptoms and appearing in a person of unimpaired strength readily proves amenable to medicine, while the one which is accompanied with grave symptoms, and evinces the concerted derangement of all the three morbific principles of the body often finds a fatal termination. The holy sages of yore have thus opined on the subject. The presence of a large concourse of distressing symptoms together with a sense of constant malaise and aching pain in the limbs, constant micturition, intene heat of the body, loss of appetite, non desire for food, and impairment of the digestive function mark a case of immature fever (amajvara or the stage of lever before the resolution of the different morbific principles which lie at its root). Heat, hyperperaxia, waterbrash, delirium, motions of the bowels, vertigo, and rapid breathing indicate that the fever is approaching its crisis (lit.,—is being matured). Rice meal should be prohibited and a light diet should be enjoined in its stead for seven days in cases where there would be reasons to apprehend the immature (unresolved) state of the deranged organic principles in fever.

The holy sages have classified the Sannipatika fever into five different kinds according to the nature of the morbific principles which serve as its exciting factors, its periodicity or time of attack, and the strength or weakness of the patient (the line may be likewise interpreted to mean according to the virulence or mildness of an attack). These five types of fever are respectively named as Santata (remittent), Satata (intermittent), Anyedyushka (appearing on every alternate day), Tritiyaka (tertian) and Chaturthaka (quotodian). The morbific principles such as the deranged Vayu, Pittam and Kapham, enraged and aggravated by their own enraging and aggravating factors, lie stuffing the ducts which carry the feces, urine, and sweat, etc., and invade as well the fundamental organic principles of the body and give rise to heat and pyrexia. The disease (fever) affects the lymphchyle (blood or the vascular system) and grows in strength and intensity without knowing any remission or abatement. It is simply unbearable in its virulence. The disease runs its course in seven, ten or twelve days according to the predominance of the deranged Vayu, Pittam or Kapham, on which days the morbific diatheses are either fully resolved and eliminated (Malapak) thus bringing on an unfavourable crisis; or the fundamental principles of the body are dried up through the agency of fever-heat and predict a fatal termination. This is the opinion of the holy Agnivesha. But according to Harita, the critical days in a case of Sannipata-fever are the seventh, the ninth, the eleventh, and the fourtenth. The patient either dies on any of these days, or passes into a state of convalescence. The course of the disease is shorter or longer according as the affected fundamental principles of the body are purified and brought back to their normal state, sooner or later. Even a small quantity of morbific diatheses present in the organism of a weak or emaciated person of unwholesome living, is augmented by, and gains in intensity from, the cumulative strength of the other morbid matter continuing therein, and thus leads to a gradual wasting of the body. Thus by causing the general wasting of the body, it brings on a type of fever which baffles all medical skill. The fever thus aggravated leads to a general break down of the constitution. On the other hand, the disease, if checked by any kind of medicine, soon suffers an abatement, the small residue of fever still remaining being absorbed in the lymph chyle. With the absorption of fever in the lymph chyle, cachexia, sallowness of complexion and lethargy also vanish. In the meantime, owing to the dilation of the vessels that carry the lymph chyle, the morbific diathesis is set free, and eliminated through the natural outlets of the body without being able to spread through the Whole organism. The type of fever, which continues without remission for a certain number of days, is called Santata (remittent). The type in which there are periods of distinct intermission or abatement is called Satata (intermittent). The type known as Vishama has no definite periodicity, nor any fixed term of continuance, and its attacks are usually nocturnal. Any morbific diathesis taking lodgment in the blood, produces Santata-type of fever. In the type known as Anyedyushka, the paroxysm comes once within twenty-four hours at the juncture of the day and night. In the Tritiyaka-type (Tertian), the vessels containing fat and carrying the essential principle of flesh are contaminated. In this fever tne patient suffers from an excruciating headache through the action of the deranged Vayu and Pittam, from an aching pain in the sacrum (extending to the coccyx) through the action of the deranged Kapham and Pittam, and from a pain along the spinal column through the action of the deranged Vayu and Kapham. The type called Chaturthaka, fever results from the contamination of either the fat, marrow, or any other secretion of the body by any of the morbific diatheses. Moreover the quotodian-fever which is confined to the marrow, makes itself manifest twice a day. In the first-named type, the paroxysm is ushered in with a numbed pain in the knee-joints and calves of the legs, while an excruciating headache markes the advent of the last-named one. The type known as the Chaturthaka-Viparyaya, has its seat in the bone and the marrow. The paroxysm comes on the first day and continues for three days in succession, completely going down on the fourth. Owing to the virulence of the morbific diatheses through injudicious diet and conduct of the patient, the deranged morbific principles are not eliminated in well-digested condition, hence arises the necessity of foregoing rice-meal and observing a light diet for seven days in this type of fever. The mind and physical acts of the patient are equally affected; and in consequence of its invading the deeper principles of the organism and the concerted action of the deranged Vayu, Pittam and Kapham therein and their equality in virulence and intensity, a case of the Chaturthaka-type of fever soon runs into an incurable one. The morbifiic diatheses go on accumulating in the remote and minute bloodvessels of the body, in consequence whereof the body does not suffer any attenuation, though the patient complains of a little heat and an uncertain kind of malaise. The disease, not checked with proper medicines at this stage of its incubation, manifests itself in nightly paroxysms of pyrexia, and other serious symptoms. The fever slowly infiltrates into the succcessive fundamental principles of the organism in proportion to the diminution of the bodily strength of the patient; and a short while after, the angry morbific diathesis incarcerated in the organism begins to work mischief and brings on its own peculiar cachexia. As a seed sown in a congenial and well-watered soil does not wait long to sprout, so the morbific diatheses, the seeds of diseases, incarcerated in a disordered human organism and nourished by their own exciting or aggravating factors, do not take a long time to take shape and manifest themselves in the form of a particular disease. As an extraneous imbibed poison carried down into the stomach, gains in strength from its own aggravating factors, and produces its harmful effects in due course of time, so the different types of Satata-, and Santata-, fever are originated in the human body.

The symptoms, which mark the type of fever restricted to the organic principle of lymph chyle, are water brash, nausea, a feeling of heaviness in the limbs, dejection, aching pain in the limbs and yawning, together with vomiting, difficult breathing and a marked non-relish for food. The following symptoms are developed in the type in which the fever invades the circulatory system (blood), viz., spitting of red (arterial) blood, thirst, and appearance of crops of dry, hot eruptions on the skin, together with a redness of the skin, vertigo, delirium, a sense of intoxication and a burning sensation of the body. Thirst, lassitude, emission of semen, an internal burning sensation in body, vertigo, jerky movements of the limbs, and fetour of the skin are the symptoms which characterise the type in which the fever invades the flesh. Perspiration with an unquenchable thirst, vomiting, fetid smell of the skin and impatience are the symptoms which mark the type in which the fever affects the fat. The type in which the fever invades the organic principle of marrow, manifests such symptoms as evacuation or elimination of the morbific matter from the system, sleeplessness, dyspnœa, convulsive movements of the limbs, together with difficult respiration and a sensation of heat in the inside, and cold on the surface of, the body. Vanishings of sight, severance or disunion of the Marmas (vulnerable bone-joints or venal, neural or arterial anestomoses), numbness of the male organ of generation, and non-emission of semen are the symptoms which are exhibited in the type in which the fever attacks the principle of semen. Each of these five types of fever are respectively more difficult to cure than the one immediately preceding it in the order of enumeration, A case of seminal fever usually ends in death. The types in which the fever affects the marrow or the semen are absolutely incurable.

The type known as Pralepaka is marked by rigour, delirium, a comparatively lower temperature of the body, and heaviness of the limbs. The patient feels as if his whole organism has been plastered with a coat of phlegm.

In the Angavalasaka-type there is small heat with numbness of the limbs, parchedness of the skin, and rigour. The patient feels as if his whole body has been stuffed with phlegm (mucous). The fever is persistent in its character and may be cured only with the greatest difficulty. In the Haridrabha-type (yellow fever), the skin, urine and feces of the patient become yollow. It is fatal as death itself. In the type known as Ratrijvara, both the deranged Vayu and Kapham of the patient’s temperament become equally dominant owing to the Pittam being considerably reduced. There is but little pyrexia in the day which is increased in the night with the aggravation of the paroxysm. The deranged Kapham (phlegm) in the patient’s body is naturally dried up by the rays of the sun as well as by the heat originated through the movements of his body during the day. Hence the small rise of the bodily temperature during day in this type of fever, which persists as a remnant of the night's paroxysm only through the action of the deranged Vayu. When the Kapham continues in the patient’s stomach, which is its natural seat, and the deranged Pittam in the abdomen, the upper part of the body remains cold, while its lower part is felt hot to the touch during a paroxysm-fever. On the contrary, when the deranged Kapham is located in the extremities, and the deranged Pittam is incarcerated in the trunk of the body, the hands and feet are felt hot, and the latter cold.

The fever, which invades the principle of lymph chyle, blood, flesh or fat, is easily curable, while the one, which affects the bone or marrow, and is detected from the atrophy and discolouring of the locality affected, can be made amenable to medicine only with the greatest difficulty. This type of fever is further characterised by unconscious or sub-comatose of tire patient, hyperpyrexia, frequent loose motions of warm muco-billious matter, and an angry look of the eyes.

Subsidence of heat and pain, appearance of sordes on the teeth or of herpetic eruptions on the lips, perspiration, with a desire for food and an unruffled state of the mind, and healthy functions of the organs of sense-perceptions are the symptoms which indicate that the fever has perfectly gone down.

Footnotes and references:

[1]:

A case of fever, which is caused by the deranged morbific principle which is naturally enraged and aggravated during any particular season of the year, is said to be seasonable (Prakrita) when it breaks out in that season. It is called Vikrita (unnatural) when contrary is the case.

[2]:

In certain parts of India.