1b. Study of Fever (Jvara) in the Caraka-Saṃhita

On the other hand, in Caraka-Saṃhitā, fever has been discussed seriously among all diseases. In Āyurveda there are many synonyms for fever, such as fever, disorder, disease, illness and panic. And with it, the causes of fever have been said to be two—physical and mental. Physical defects are arthritis, bile and phlegm. And the mental faults are-Rājasa and Tāmasa.

According to Bhāvaprakāśa—

‘jvaratītijvaraḥ, jvararoge |’.

Amarakoṣa has accepted fever as a type of ailment–

‘jvaramehabhagandarāḥ’.

Currently, a rise in body temperature above 37℃, or 98℉, is called fever^[1]. In Caraka-Saṃhitā, Fever has been given prime importance among all diseases^[2]. So, the description of fever comes first in this book. According to Caraka-Saṃhitā, the growing temperature in both body and mind is called Fever^[3]. Growing body temperature means heating the body and mind temperature means tensions and exhaustion of mind. In Yogaratnākar's view—Vātādi doṣa, represented by false diet-vihara, following the rasa-dhātu located in the stomach and by extracting the Jaṭharāgni, they produce fever. That is, it irritates the body. The same anguish is called fever^[4].The meaning of the term Fever is little extensive in Caraka-Saṃhitās. It encompasses different maladies like fever, insanity, discomfort, disease and anxiety.

As Caraka Saṃhitā defines:

“jvarau vikāro rogaśca vyādhirātaṅka eva ca |
ekārthanāmaparyyāyairvividhairabhidhīyate ||”^[5]

Parimal Publication, 2015, p. 569.

In Caraka-Saṃhitā fever is identified by several alternative terms such as roga, Vyādhi, vikāra and Ātaṅka. The origin of fever is the vitiated doṣas of body and mind for the reason that fever does not occur in the individual devoid of the same. That is the inequity of somatic and psychic doṣa. Rudra’s wrath is the origin of Fever^[6].

Myths about the basis of Jvara is in the second age or Tretā Yuga when Lord Śiva took an oath not to reveal fury for one thousand cosmic years. The devils, during this time, indulged in making impediment to the atonement of Ṛṣis by playing mischiefs. Dakṣa Prajāpati was efficient in preventing their impediments to the penance. Moreover, he refused to give due place to the offerings to Lord Śiva in the sacrifice despite the advice by the Gods. Thus, sacrificed without the mantras concerning the Lord of animals and offers relating to Lord Śiva which were essential for the success of the sacrifice. When, the God Rudra, after the accomplishment of the vow, got to know the fault of Dakṣa, he came into the furious state and opened his third eye on his forehead and slashed down all these demons to ashes and created a boy who was heated with the fire of fury. He could annihilate celebrations of the sacrifice. Thus, the sacrifice was destroyed, the Gods were disturbed, and the living beings tormented with heat and pain. Then all the Gods along with the seven sages worshipped the God with prayers till Lord Śiva reverted to his normal generous form. Realizing that he is now in the benign temperament, the fire of rage who possesses three heads, nine eyes, and is perturbed with blazing flares approached Lord Śiva and enquired from him about his imminent work. The Lord Śiva replied–'You will suffer from fever between birth and death and also in conditions of unwholesomeness'^[7]. Mādhava Nidāna says fever is caused by the exhalation of Rudra after getting furious when humiliated by Dakṣa. There are eight kinds of fever^[8]. The eight reasons liable for fever in human beings are Vāta, pitta, Kapha, Vātapitta, Vātakapha, Pittakapha, Vātapittakapha and extrinsic factors^[9]. According to Aṣṭāṅga Hṛdayaṃ fever is the king of the ailments. It feeds on ojas leading to death which originates from the third eye of Lord Siva and it produces delusion^[10].

By characteristics, fever is associated with Yama and is also known as kṣaya, tamas, pāpmā. and mṛtyu. The origin of Jvara is because of the parigraha^[11].

Consequences of fever are temperature above the normal range, anorexia, dehydration, body ache and difficulty in the cardiac region. The eight causes of fever are Vāyu, Pitta, Vātapitta, Vātaśleṣmā, Pittaśleṣmā, Kapha, Vātapittaśleṣmā and Āgantu. Prodromic warning signs of fever are loss of appetite, lethargy, congested eyes, lacrimation, excessive sleepiness, lethargy, yawning, flexion, trembles, exhaustion, colic pain, dizziness, hallucination, insomnia, loss of strength and complexion, distaste in mouth, cold, wind and sun; dislike to sweet food, liking four sour, saline and hot food etc.^[12] According to Aṣṭāṅga Saṃgraha there are eight reasons for fever^[13]. The symptoms include lethargy, loss of appetite, excess of sleep etc.^[14] According to Suśruta Saṃhitā, only human beings can tolerate fever for possessing sacredness. Fever can be caused by infection, erosion, injury to the nerve and consumption of particular medications^[15]. The moment of exacerbation is where Vāta Jvara is more at the end of absorption of food; Pitta jvara is more during the absorption of food, in the midday and midnight; and Kapha Jvara rises instantly after eating, usually in the morning and late evenings. Feature of Jvara is when Santāpa affects the mind. The symptoms are mental instability, lethargy and in case of Santāpa, the Indriya become unbalanced.

The precise character of fever is the abnormal temperature in the body. The fever rises in a specific time because of strength or otherwise of the season, day and night doṣas and deeds^[16].

Regarding the classification, fever has two varieties, e.g., Somatic and Psychic. Moreover, it is of two types–saumya which is predominant in soma and āgneya which is predominant in Agni. It is again of two types, e.g., natural and unnatural, internal and external, curable and incurable. Takman again is of five types according to intensity and vulnerability of the timing of doṣa like Santatā or remittent, Satatā which is rising twice a day, Anyedyuska or quotidian, Tṛtīyaka or tertian and Cāturthaka or quartan. According to place in dhātus, it is of seven forms. Etiologically, it is again of eight types. Though fever is, basically psychosomatic, the somatic fever first begins in the body while the psychic fever begins in the mind. Psychological denigration, anxiety and depression are the symptoms of psychic fever. Fever also triggers a malfunction in senses^[17]. Vāyu is a vital synergist employs both forms of action on arrangement. It produces heat when combined with 'Pitta' but in combination with Soma i.e., Kapha generates chill.

According to modern medical science different types of fever are Influenza Fever, Yellow Fever, Scarlet Fever, Kala-Azar Enteric Fever, Fever Rheumatic Fever, Diphtheria Fever, Recurrent Fever, Dengue Fever, Typhoid Fever, Tonsillitis Fever, Srikantha Murthy, Varanasi, Chaukhambha Orientalia, 2018, p.149.

Glandular Fever, Tetanus fever, Smallpox Fever, Pneumonia fever, Relapsing fever, Bilious fever, Paratyphoid fever, Malaria fever, Hectic fever, puerperal fever, Filarial fever, Meningitis fever, Jaundice fever, Viral Hepatitis fever, Poliomyelitis fever, Aphthous fever, T.B or Phthisis fever, Intermittent fever, Constant or continuous fever, Sun-stroke fever, Eruptive fever, Milk fever, Septicaemia fever, Obstructive Gallstone fever, Parenchymatous Nephritis fever, Bronchitis fever, Cold & Cough fever, Plague fever, Venereal Syphilis & Gonorrhoea disease infection fever, Urinary tract Infection fever, Hectic fever, Glandular fever, Pleura Inflammation fever, Dysentery fever, Hay fever^[18].

Internal fever generates more inner temperature, thirst, anxiety, increased respiration, vertigo, pain in joints and bones, lack of sweat, an obstacle in doṣas and faces. External fever generates extreme outward heat, the mildness of thirst etc. along with easy curableness. Kapha is linked as a contributory component. In such conditions fasting causes no detriment because of the nature of visargā or releasing. Alternatively, Kapha is caused by sweet water and plants during the season of Hemanta and gets vitiated in spring in the middle of the ādāna. Here vāta and Pitta occur as contributory factors.

A prudent physician should treat a patient having a fever in autumn and spring by taking into account the intensity and vulnerability of doṣas in the beginning, the end and the middle. Fever is called prakṛta or natural based on Prakṛti or nature of time. However, the vātika fever or a prākṛta one may prove problematic. Fever arising in seasons other than the one which is responsible for the concerned doṣa is known as vaikṛta i.e., unnatural.

Fever can be cured if it has no difficulties and occurs in persons having strength and morbidity. Fever may be deadly when caused by numerous and potent etiological factors and has numerous symptoms and destroys the senses quickly. Acute fever accompanied by confusion, dizziness and dyspnoea kills a patient in a weak or ten to twelve days. The ten complications of fever are cough, unconsciousness, anorexia, thirst, diarrhoea, constipation, breathlessness, hiccough, vomiting, and myalgia^[19].

Severe fever and the one marked by the parting line of the hair in emaciated and swollen persons are incurable. The heavy doṣas spread all over the body through the channels carrying rasa and stiffened gave rise to Santata Jvara or remittent fever^[20]. Being unbearable and quick-acting it gets subsided or kills the patient by the period of seven, ten or twelve days. Doṣa, equal in respect of time, dūṣya or affected tissue and constitution and having no counter-acting factor, causes the remittent fever and as such is quite unbearable. In remittent fever, as a rule, Vāta etc., also affect urine and faeces simultaneously as the dhātus. This fever gets subsided or becomes fatal in periods of a week etc. according to condition whether rasa etc. have been purified completely or not. `When they are not purified completely or entirely the remittent fever gets lodged in the twelve entirely (seven dhātus) three doṣas, urine and faeces. Thus, even after remission on the twelfth day, it continues hidden for a long time without responding to any treatment. Considering all this, the physician should treat the cause of fever. Mostly in such management, desiderating remedies are administered at first. Doṣa is often lodged in Rakta dhātu and with some counteracting factor causes Satataka Jvara which rises and falls according to corresponding time. The Satataka Jvara rises twice in twenty-four hours^[21].

Anyedyuṣka or quotidian fever is caused by doṣa which gets support from one of the factors such as time, constitution and dūṣya obstruct the vessels carrying medas in the presence of the counteracting factor. In this, fever rises once in twenty-four hours. The doṣa lodged in asthi (bone) and majjā (marrow) causes tertian and quartan fevers. The paroxysm of doṣa is at the interval of two days, one day or daily. The others describe otherwise such as–quotidian fever is caused by the doṣa even if it is lodged in Rakta. If it goes to the channels of māṃsa, it causes tertian fever while it gives rise to the quartan fever of it is lodged in the channels of medas. The quotidian fever comes daily the tertian on a day's interval and the quarter at the interval of two days^[22].

As a seed lies dormant in the soil (for a while) and grows up in (favourable) time, doṣas stay in Dhātus and get vitiated in opportune time. The doṣa having attained exacerbation and timely strength due to weakening of the counteracting factor gives rise to the tertian as well as the quartan fever.

After the paroxysm, the doṣas are being weakened, stay in their respective places and being later reinforced in their opportune times again give rise to fever.

1. Due to Kapha and Pitta starting from trika (sacral region)
2. Due to vāta and Kapha starting from the back and
3. Due to vāta and Pitta starting from the head.

Likewise, the quartan fever also has two types of characters—

1. one caused by Kapha and starting from logs and
2. the other caused by vāta and starting from the head.

The other type of Viṣama Jvara or intermittent is the reverse quartan fever which is caused by the three doṣas separately situated in two dhātus (asthi and majjā). The five types of Viṣama fever are often due to combination of all the three doṣas but practically the dominant one is called as the cause^[23].

Different types of Viṣama Jvara-(1) Santata Jvara–the fever which continuously exists for seven, ten or twelve days. (2) Satataka Jvara–fever occurs one in day and night respectively. (3) Anyedyuṣka Jvara–fever occurs once in twenty-four hours. (4) Tṛtīyaka–the fever which occurs on every third day. (5) Cāturthaka–the fever which occurs on every fourth day. Along with this, different types of Viparyaya could be discussed: e. g. Satata Viparyaya, Anyedyuṣka Viparyaya, Tṛtīyaka Viparyaya and Cāturthaka Viparyaya^[24].

Heaviness, anxious expression, agitation, malaise, vomiting, anorexia, external heat, body-ache and yawning-these are the symptoms of the fever located in rasa or dhātu. Red and hot boils, thirst, frequent haemoptysis, burning sensation, redness, giddiness, narcosis and delirium are the symptoms of fever located in rakta or dhātu. Internal heat, thirst, frequent haemoptysis, burning sensation, redness, giddiness, narcosis and diarrhoea are the symptoms of fever located in rakta or dhātu. Internal heat, thirst, fainting, malaise, diarrhoea, foul smell and convulsions are the symptoms of the fever located in māṃsa or dhātu. Diarrhoea, vomiting, tearing pain in bones, groaning, convulsions and dyspnoea-these are the symptoms of the fever located in asthi or dhātu. Hiccup, dyspnoea, cough, darkness before eyes, cutting pain in vital parts, externally cold but internally burning sensation–these are the symptoms of the fever located in majjā or dhātu. The fever located in śukra or dhātu liberates semen, destroys the vital strength and departs from the body along with Vāyu, Agni (Pitta) and soma or Kapha. The fever located in rasa and rakta is curable, that located in māṃsa, medas, asthi and majjā is curable with difficulty and that located in śukra is incurable^[25].

The eight types of fever have been described concerning their etiology and symptoms collectively and now their symptoms are being described individually. Headache, tearing pain in smaller joints, burning sensation, horripilation, dryness of throat and mouth, vomiting, thirst, fainting, giddiness, anorexia, insomnia, delirium, yawningthese are the symptoms of fever caused by Vāta and Pitta^[26]. Doctors say Dvidoṣaja fever is Remittent fever. There are three types of Remittent fever namely–Vātapittaka, Pittaśleṣmika and Vātaśleṣmika^[27]. Feeling of cold, heaviness, drowsiness, feeling of wetness, pain in smaller joints, headache, coryza, cough, lack of perspiration, pyrexia and medium intensity–these are the symptoms of fever caused by Vāta and Kapha^[28]. The frequent alternate feeling of cold and heat, frequent alternate perspiration and nonperspiration, fainting, cough, anorexia, thirst, discharge of mucus and bile, sliminess and bitterness in mouth and drowsiness-these are the symptoms of fever caused by Kapha and Pitta^[29]. Thus, the fevers caused by duals are two doṣas jointly described^[30]. According to Kāśyapa Saṃhitā, there are two types of fever at the source and eight types at the place of diagnosis^[31].

Vāta gets aggravated by the overindulgence in the intake of ununctuous, light and cold things, over the administration of emesis, purgation, āsthāpana type of enema, errhines, physical exercise, suppression of the natural urges, fasting, assault, sexual indulgence, anxiety, grief, blood-letting in excess, vigil during the night and by maintaining irregular posture. This aggravated vāta afflicts Āmāśaya, gets mixed up with Agni, follows the course of rasa which is the first product after the transformation of food, obstructs the channels of rasa and sweat, suppresses the activity of Agni, extradites the heat from the site of digestion and spreads at all over the body, thus causing Fever. The symptoms of Vatic fever are irregularity in onset and alleviation; irregularity in temperature; irregularity in the acuteness and mildness of fever; occurrence or aggravation of fever after the digestion of food in the afternoon during dawn or at the end of summer season; excessive roughness and reddishness of nail, eyes, face, urine, stool and skin; excessive retention of urine and stool; occurrence of different types of fixed of shifting pain in various organs of the body; feeling of looseness in knee joints as also in other joints; inactivity of thigh; breaking, bursting, grinding, churning, cracking, bursting and twisting pain in waist, sides, back, shoulders, arms, scapular region and chest; stiffness of jaws; noise in the ears; pain in temples; astringent taste in the mouth or dysgeusia; dryness of mouth, palate and throat; thirst; impairment of the functions of heart; dry vomiting; dry cough; suppression of sneezing and eructation; aversion to the taste of food; salivation, anorexia and indigestion; depression, yawning, flexion of the body, trembling, exhaustion, giddiness, delirium, sleeplessness, horripilation, setting at edge of teeth; liking for hot things; aggravation of the condition by the administration of such things as are described to be its etiological factors; and alleviation of the condition by the administration of such things as are of opposite qualities to its etiological factors^[32].

Pitta gets aggravated by the excessive intake of hot, sour, saline-alkaline and pungent food, intake of meals while suffering from indigestion and exposure to the scorching sun, the heat of the fire, exhaustion, anger and irregular dieting. This aggravated pitta approaches the site of Agni in the Āmāśaya, follows the path of rasa which is the first product of food after transformation, obstructs the channel of circulation of rasa and sweat, impairs agni due to its liquidity, extradites agni from the site of digestion, inflicts pressure and spreads all over the body, thus causing jvara.

The symptoms of pitta fever are–Simultaneous manifestation or aggravation of fever in the entire body, all at a time, especially during the process of digestion, during the mid-day, mid-night and in the autumn; Pungent taste in the mouth; Inflammation of nose, mouth, throat, lips and palate; Thirst, intoxication, giddiness and fainting; Bilious vomiting, diarrhoea, aversion for food, lassitude, exhaustion and delirium; Appearance of reddish urticaria in the body; Greenish or yellowish colour of nails, eyes, face, urine, stool and skin; Hyperpyrexia; Excessive burning sensation; Liking for cold things; Aggravation of the condition by the administration of such things as are described to be its etiological factors; and Alleviation of the condition by the administration of such things as are of opposite qualities to its etiological factors^[33].

Kapha gets aggravated by the excessive intake of unctuous, heavy, sweet, slimy, cold, sour and saline food, sleep during day time, merriment and lack of physical exercise. This aggravated Kapha enters the Āmāśaya, gets mixed up with agni, follows the course of rasa which is the first product of food after transformation, obstructs the channels of circulation of rasa and sweat, suppresses the activity of agni extradites heat from the site of digestion, inflicts pressure and spreads it all over the body thus causing fever^[34]. The symptoms of Ślaiṣmika jvara are–Simultaneous manifestation or aggravation of fever in the entire body especially immediately after-food, during the forenoon, in the evening and during the spring season; Heaviness of the body, loss of appetite, salivation, sweet taste in the mouth, nausea, bradycardia, limpidness and vomiting; Reduced power of digestion, excessive sleep, stiffness, drowsiness, cough, dyspnoea and coryza; Feeling of cold; the White colour of nails, eyes, face, urine, stool and skin; Frequent appearance of a large number of cold pimples in the body; Liking for hot things; Aggravation of the condition by the administration of such thing as are described to be its etiological factors; and Alleviation of the condition by the administration of such things as having qualities opposite to its etiological factors.

The fever is caused by three doṣas. The symptoms of the thirteen types of Sannipāta Jvara will be described. Giddiness, thirst, burning sensation, heaviness, excessive pain in the head–these are the symptoms in fever caused by Vāta-Pitta as severe and Kapha as mild. Cold sensation, cough, anorexia, drowsiness, thirst, burning sensation, pain, and distress–these are the symptoms in fever caused by severe Vāta and Kapha and mild Pitta. Vomiting, alternating cold and hot sensation, thirst, fainting, pain in bones–these are the symptoms in fever caused by severe Pitta and Kapha and mild Vāta. Pain in joints, bones and head, delirium, heaviness, giddiness, thirst, dryness of throat and mouth–these symptoms are found in fever caused by severe Vāta with subsidiary Pitta and Kapha. Red faces and urine, burning sensation, sweating, thirst, weakness and fainting–these are the symptoms in fever caused by severe Pitta. Lassitude, anorexia, burning sensation, vomiting, restlessness, giddiness, drowsiness and cough–these are the symptoms of fever caused by severe Kapha. Coryza, vomiting, lassitude, drowsiness, anorexia, and poor digestion–these are the symptoms of fever caused by severe Kapha, moderate Pitta and mild Vāta. Yellow urine and eyes, burning sensation, thirst, giddiness and anorexia are symptoms of fever caused by severe Pitta, moderate Kapha and mild Vāta. Headache, tremors, dyspnoea, delirium, vomiting and anorexia are the symptoms of fever caused by severe Vāta, moderate Kapha and mild Pitta. Feeling of cold, heaviness, drowsiness, delirium, excessive pain in bones and head are the symptoms of fever caused by severe Kapha, moderate Vāta and mild Pitta. Dyspnoea, cough, coryza, dryness of mouth, and excessive chest pain are the symptoms of fever by severe Vāta, moderate Pitta and mild Kapha. Diarrhoea, poor digestion, thirst, burning sensation, anorexia and giddiness are the symptoms of fever by severe Pitta, moderate Vāta and mild Kapha^[35].

The symptoms of the Sannipāta Jvara will be described such as–the momentary sensation of heat and cold, pain in bone joints and head; tearful, dirty, red and crooked eyes, ears with tinnitus and pain, throat as if covered with awns, drowsiness, fainting, delirium, cough, dyspnoea, anorexia, giddiness; tongue as if charred and roughened, excessive laxity in organs, haemoptysis, turning of the head, thirst, insomnia, cardiac pain, delayed and little elimination of sweat, urine and faces, limbs not much emaciated, continuous groaning, the appearance of rashes and blackish and reddish patches, muteness, inflammation in channels, heaviness in the abdomen and delayed digestion of doṣas. Sannipāta-Jvara is incurable if doṣas are bound up, power of digestion is lost and the symptoms are present in entirety and full otherwise it is curable with difficulty^[36].

In the Aṣṭāṅga Hṛdaya, some causes of Sannipāta fever have been specified. For example, when three doṣas such as arthritis, bile and phlegm are combined, it is called Sannipāta. Sannipāta fever is caused by a narrow diet, indigestion, adhyaśana, contaminated water, eating contaminated meat, eating contaminated food, sinful behaviour etc. Symptoms of Sannipāta fever are-the frequent burning sensation in the body, frequent chills, deep sleep during the day, tears in the eyes, relaxation in the body, blood bile and phlegm with saliva, headache, in the heart pain, constipation, etc.^[37]

According to the second classification of the book, Bhāvaprakāśa in Bhāvamiśra, the variety of Sannipāta-Jvara is mentioned below–

Śītāṅga Sannipāta-Jvara–the main symptoms are cooling the body.
Pralāpaka Sannipāta-Jvara–the main signs are flirtatious.
Raktaṣṭhīvi Sannipāta-Jvara–the main symptoms are blood out with the spit.
Bhugnetra Sannipāta-Jvara–one or two eyes are blinded by the main symptoms.
Abhinyāsa Sannipāta-Jvara–the main signs are swoon.
Jihvaka Sannipāta-Jvara–the main symptom is the cutting of the tongue.
Antaka Sannipāta-Jvara–the symptoms of death in the face of major signs are manifest.
Rugdāha Sannipāta-Jvara–the main signs are the inflammation of the whole body.
Tāntrika Sannipāta-Jvara–the main symptom is depression.
Sandhiga Sannipāta-Jvara–the main symptom is the pain on every joint of bone and swelling.
Cittabhrama Sannipāta-Jvara–the main symptom is mind illusion.
Kaṇṭhakubja Sannipāta-Jvara–the main symptom is the feeling of itching in the throat.
Karṇika Sannipāta-Jvara–the main symptom is terrible pain and swelling of the ear.^[38].

According to the third classification of the book, Bhāvaprakāśa in Bhāvamiśra, the variety of Sannipāta-jvara is mentioned below–

Kumbhīpāka Sannipāta-Jvara–this fever is like the infatuation of Kumbhīpāka hell.
Prorṇunāva Sannipāta-Jvara–terrible pain inflicted fever.
Pralāpi Sannipāta-Jvara–delirium fever.
Antardāha Sannipāta-Jvara–having a terrible fever inside body.
Daṇḍapāta Sannipāta-Jvara–having lost sense, a patient falls on the ground like a branch.
Antaka Sannipāta-Jvara–high fever mixed with terrible pain and with a sign of death.
Enīdāha Sannipāta-Jvara–patient’s directionless body movement with pain throughout the body.
Hāridraka Sannipāta-Jvara–a patient’s eye, mouth stool and urine get yellow.
Ajadhoṣa Sannipāta-Jvara–a patient’s voice gets choked and starts shouting like a goat.
Bhūtahāsa Sannipāta-Jvara–patient's sudden unnatural behaviour.
Yantrāpīḍa Sannipāta-Jvara–a patient’s every organ starts paining.
Saṃnyāsa Sannipāta-Jvara–a patient loses the sense of the idea of good and bad.
Saṃśoṣi Sannipāta-jvara–patient’s eye gets black. The whole body started to have deep marks^[39].

According to Śāraṅgadhara Saṃhitā, there are twenty-five types of fever present. Namely–one from each of the tridoṣas, one each by the combination of two doṣas–Dwandwaja, one from the combination of all three doṣas together Sannipātaja with its many Subdivisions; Viṣama-Jvaras are usually five -Santata, Satata, Anyedyuṣka, Tṛtīyaka and Caturthaka; similarly is the Āgantu-Jvara with thirteen kinds caused by Abhicāra (Witchcraft), Grahaveśa (Evil spirits), Śāpa (Curse), Śrama (exertion), Cheda (injury by sharp weapons), Kṣata (injury by blunt weapons), Dāha (burns), Kama (lust), Bhaya (fear), Aśuca (uncleanliness), Cintā (worry), Rosa (anger), Viṣa (Poison), and Auṣadhigandhaja (contact with pollen, Strong smell etc.).^[40]

Fig. 3: Classification of different types of Āgantuka-Jvara

[Śāraṅgadhara Saṃhitā define different types of Āgantuka-Jvara^[41] ]
[Source: Caraka-Samhita–Vol. II]

[Abhicāraja Grahāveśaja Śāstraja (Abhiṣaṅgaja) (Māraṇa-Mohana-Ucāṭana) (Grahanakṣatraja pīḍā) (From Mother, father and Guru etc. is wrath) Labor (Śrama) Severance (Cheda) Wound (Kṣata) Inflammation (Dāha) Kāmaja Bhayaja Śokaja Krodhaja Vaṣaja Auṣadhigandhaja]

The exogenous fever, the eighth one, is mentioned as of four types such as caused by injury, ill attachment, exorcism and cursing. That caused by injury comes forth where the body is injured with a weapon, brickbat, whip, wood stick, fist, slap, teeth or other such means. In such conditions due to injury Vāyu gets aggravated and often affecting blood produces fever along with pain, swelling, abnormality in colour and distress^[42].

Fever caused by ill attachment with passion, anxiety, fear or anger and also by infection of organisms knows ‘Abhiṣaṅgaja Jvara’. Passion, anxiety and fear aggravate Pitta and infections of organisms aggravate all the three doṣas manifesting symptoms according to the organism concerned. Eight types of such syndromes have been described in the context bhūtas^[43]. Some also take the fever caused by contact of poisonous air as Abhiṣaṅgaja which gets pacified by the anti-poison treatment. The fever caused by exorcism and cursing of the accomplished persons is associated with all the doṣas vitiated and is very severe and unbearable. It exhibits symptoms of Sannipātaja-jvara along with other afflictions of mind, senses and body. The application of exorcism is known by seeing and hearing himself or by inference through its pacification. Due to the variousness of exorcism and cursing, the symptoms in respective cases are observed differently according to practice and application. In the fever caused by passion, the symptoms are predominantly tearing (in eyes), that caused by fear has terror, the fever caused by poisonous contact predominant symptoms are fainting, confusion, narcosis and malaise. In some cases, fever rises before the above symptoms appear while in other cases it comes forth after them or simultaneously with them. The features of the fevers caused by passion etc. are also found in other diseases caused by them. On infliction of mind with passion etc., the fever does not get strength until the body is affected with Vāta etc. Similarly, on the infliction of the body with Vāta etc. the fever does not get hold until the mind is affected with passion etc. The exogenous fevers are at first insisted but later on get symptoms combined with those of innate factors. They are also specific concerning etiology and therapeutics. The vitiated doṣas, duals, aggregated or single, associate them with rasa dhātu while expelling the Agni from its place and adding to the body-heat with their heat and the heat of (displaced) Agni, also blocking the channels spread all over the body with aggravation and thus produce pyrexia. The patient gets his entire body heated and thus is said as suffering from over. The patient of fever does not perspire due to blocking of channels. During the stage of acute or immature (Āma) fever, he suffers from anorexia, indigestion and heaviness in abdomen, the impurity of heart, drowsiness, lassitude, continuous and high fever, nonelimination of doṣas, excessive salivation, nausea, loss of appetite, distaste in mouth, limbs as stiffened, numbed and heavy, polyuria, stool immature and absence of emaciation–these are the symptoms of Āma (immature) fever^[44]. High fever, thirst, delirium, dyspnoea, giddiness, elimination of excrements and nausea–these are the symptoms of pacyamāna (maturing) fever^[45]. Appetite, emaciation, lightness in the body, mild fever, elimination of doṣas, and passing of eight days–these are the features of Nirāma (mature) fever. In acute fever or Nava jvara, one should avoid day-sleep, bath, massage, solid diet, sexual intercourse, anger, wind, exercise and also extracts (of Drug)^[46]. In fever, first of all, lightning therapy is recommended except in that caused by wasting, Vāta fear, anger, passion, anxiety and exertion. Due to lightening morbidity is alleviated and the digestive fire is kindled, consequently, apyrexial, lightness and appetite arise. Lightning therapy which does not conflict with the strength of the patient should be applied because health depends on strength which the therapeutic management is intended for^[47]. Fasting is prescribed in the primary stage of fever. Here, intake of light diet in addition to fasting is prescribed Thereafter, depending upon the doṣa involved and the therapeutic propriety, the patient should be administered decoction, drink, unction, oleation, fomentation, ointment, bath, pasted medicine, emesis, purgation, āsthāpana type of enema, alleviation therapy, inhalation, fumigation, smoking, collyrium and milk preparations^[48].

In acute fever lightening, sweating, time, gruels and bitters are digestive for immature doṣas. In the condition of thirst, hot water should be given in Vātakaphaja fever while in that caused by wine and Pitta cold water boiled with bitters is advisable. Both the above types of water are appetizer, digestive, antipyretic, channel-cleansing, strength promoting, producing relish and sweating and are wholesome^[49]. Water boiled with musta, parpaṭaka, Uśīra, Candana, Udīcya and Śuṇṭhi and self-cooled should be administered to alleviate thirst and fever. In fever which is caused predominantly by aggravated Kapha situated in Āmāśaya (stomach) with the tendency to come out and the patient is fit for vomiting the doṣas should be eliminated by administering emetics. If emetic is administered in an acute fever when the doṣas are not tending to come out it is liable to produce heart-disease, dyspnoea, hardness in bowels and mental disturbance. To attempt to eliminate the doṣas which are spread all over the body, associated with Āma, seated in dhātu and extractable with difficulty is risky like attempting to extract juice from unripe fruits^[50].

After emesis and lightening the patient should be provided with gruels in time cooked with respective drugs starting with scum-gruel in the beginning till the fever comes down or for six days. By this Agni is stimulated like fire by fuel. Due to medication and lightness, they are appetizer, carminative for wind, urine, faces and doṣas; due to being hot and liquid they are diaphoretic; due to being liquid they alleviate thirst, due to being nutrient they provide strength; due to being laxative, they produce lightness and due to being suitable in fevers they act an antipyretic. Hence the wise physicians, from the very beginning, manage the cases of fever with gruels except in that caused by wine. Gruel is not advised in fever associated with alcoholism, alcoholic addicts, in summer, having a predominance of pitta and Kapha or with upward internal haemorrhage (haemoptysis, epistaxis etc.). In such cases, saturating drinks of parched paddy flour or antipyretic fruit juice should be given along with honey and sugar. Considering suitability and strength, these diets should be given along with green gram soup or soup of the meat of wild animals after the saturating drink is digested. At the time of the meal, the patient should be advised to brush his teeth with a twig which has taste contrary to that of his mouth and is according to his liking. This produces non-sliminess in mouth, desire for food and drinks and sharpened perception of the taste sensation. After cleaning his teeth with the plant-twig and washing his mouth many times, he should take meals along with curd-water, sugarcane juice, wine etc., as directed^[51].

In case of fever, after six days have passed, the physician after giving a light diet should administer digestive or pacifying extract of drugs. If extracts are administered in acute fever, they bind up the doṣas due to astringency which are held up without being digested and thus cause Viṣama-jvara (intermittent fever). Extract as preparation is not contraindicated in acute fever but the extract of astringent drugs. One should eat light food along with beneficial vegetable soups, soured or unsourced, or soup of the meat of wild animals till ten days for the alleviation of fever. Thereafter in case of fever having mild Kapha and severe Vāta and pitta and with doṣas well digested, intake of ghee acts like nectar. In case even after ten days there is the predominance of Kapha and the patient is not lightened completely, the physician should not use ghee but should treat him with extracts till lightness is attained along with the diet with meat-soup because strength is necessary to overcome the disorders and it (meat soup) provides strength. In the case of the fever causing burning sensation and thirst, having a predominance of Vāta and pitta, doṣas constipated or discharged profusely and freedom from Āma, intake of milk should be advised. If the fever does not subside even by these measures, one should pacify it by purgation if the patient has unimpaired strength, musculature and Agni^[52].

In patients reduced by fever, neither emesis nor purgation is beneficial. In such cases, the excrements should be eliminated by adequate intake of milk or administration of non-unctuous enema. Non-unctuous enema, if applied on full maturity of doṣas, provides strength, digestive power, and freedom from fever, happiness and relish quickly. Purgation eliminates pitta or Kapha-pitta situated in Pittāśaya while enema eliminates all the three doṣas situated in Pakvāśaya. In chronic fever when Kapha and pitta are reduced, appetite infirm and stool is rough and constipated, an unctuous enema should be applied. In chronic fever, if there are heaviness and pain in head and senses are blocked head-evacuation should be applied which also provides relish. The physician should advise massage, anointing, sprinkling and bath, cold or hot, as necessary. By these, the fever situated in external passages is pacified, organs get pleasure and strength and complexion are promoted. The cases of chronic fever having remnant only in the skin and where there is the association of some extrinsic factor get relief from the application of incense and collyrium. Thus, the successful therapeutic management of fever is described. Hereafter the drugs used in the therapy will be mentioned. For the patients of fever, the old cereals of red śāli, ṣaṣṭika etc., are recommended for use in the forms of gruel, boiled rice and parched paddy which alleviate fever. The patient of fever with poor digestion should, at first, take when hungry the gruel made of parched paddy boiled with long pepper and ginger which is easily digestible and alleviates fever. One fond of sours may take the same soured with pomegranates and added with ginger. One having diarrhoea and predominance of pitta should take it cold and added with honey. The patient having complications of pain in sides, pelvis and should take the gruel of red śāli rice cooked with Gokṣura and Kaṇṭakāri. It alleviates fever too^[53]. The patient suffering from fever and diarrhoea should take soured liquid gruel cooked with Pṛśniparṇi, Balā, Bilva, Śuṇṭhi, Utpala and Dhānyaka. The patient of fever having cough, dyspnoea and hiccup should take the gruel cooked with the (drugs of) vidārigandhādi group which is the appetizer and diaphoretic^[54]. The patient of fever having constipation should take the liquid gruel having barley cooked with long pepper and Āmalakī fruits and added with adequate quantity of ghee. It acts as a carminative. The patient of fever having constipation and abdominal pain should take liquid gruel cooked with Mṛdvikā, Pippalīmūla, Cavya and Śuṇṭhi. In fever associated with cutting pain in the abdomen, one should take the liquid gruel with Bilva and cooked with Balā, Vṛkṣāmla, Kolāmla (sour jujube), Pṛśniparṇi and Kaṇṭakāri. The patient having no diaphoresis and sleep and having excessive thirst should take the liquid gruel fried with ghee and cooked with Śuṇṭhi and Āmalaka and added with sugar. This acts as antipyretic. The patients of fever suited to pulse soup should be advised to take the same of green gram, lentils, grams, horse gram and makuṣṭhaka. Leaves and fruits of Paṭola, Kārvaellaka, Pāṭhā, Karkoṭaka and Kaṭhillaka–these vegetables are wholesome for those suffering from fever. Those who are nonvegetarians may take the soup of Lava (common quail), Kapiñjala (grey partridge) Eṇa (a type of deer), Cakora, Upacakraka, Kuraṅga, Kālapucchak [Kālapucchaka], Hariṇa, Pṛṣata (a type of deer) or Śaśa (rabbit) unsourced or slightly soured. Some physicians do not recommend the meat of cock, peacock, partridge, heron and Bartaka (a quail) in fever due to their property of heaviness and hotness. But (in Ātreya's view) if there is the severity of Vāyu due to lightning the wise physician should administer them as well considering time, dose and preparation. If there is thirst, hot water should be given for after-drink or wine to those who are addicted to it considering the doṣa and strength of the patient^[55]. To facilitate the maturation of doṣa one should mostly avoid in acute fever the dietary articles which are heavy, hot, unctuous, sweet and astringent^[56]. Thus, the accomplished dietetic management for fever is described. Hereafter the antipyretic extracts will be mentioned: 1. musta and parpaṭaka together should be taken in the form of cold infusion or decoction or 2. Śuṇṭhi, parpaṭaka and Durālabhā may be taken (in the same way), 3. Kirātatikta, Musta, Guḍūcī, Śuṇṭhi, Pāṭhā, Uśīra and Udīcya may be taken. These extracts are antipyretic appetizer, digestive for doṣas and alleviate thirst, anorexia and distaste of mouth. (1) Indrayava, Paṭola leaves, Kaṭurohinī; (2) Paṭola, Sārivā, musta, Pāṭhā, Kaṭurohinī; (3) Nimba, Paṭola, Triphalā, Mṛdvikā, musta and Kuṭaja; (4) Kirātatikta, guḍūcī, Candana and Śuṇṭhi; (5) Guḍūcī, Āmalaka and musta–these five (formulations for) decoctions ending in half verses alleviate five types of fever such as remittent, double quotidian, quotidian, tertian and quartan^[57]. Kuṭaja, Āragvadha, Pāṭhā, Haimavati, Kaṭurohinī, Mūrvā, Ativiṣa, Nimba, Paṭola, Dhanvayāsa, Vacā, musta, Uśīra, Madhuka, Triphalā and Balā–this formulation should be taken in fever in the form of decoction or cold infusion. Madhuka, musta, Mṛdvikā, Kāṣmarya, Paruṣaka (fruits of these three), Trāyamāṇā, Uśīra, Triphalā and Kaṭurohinī–all together should be kept overnight in water and taken in the morning. This alleviates fever quickly. Jāti (leaves), Āmalaka, musta and Dhanvayāsa-decoction of these drugs added with jaggery should be taken by a constipated patient of fever. Triphalā, Trāyamāṇā, Mṛdvikā and Kaṭurohinī–this decoction is laxative and eliminates pitta and Kapha. Trivṛtā (in the form of decoction) added with sugar is efficacious in pitta-Kaphaja fever. Bṛhatī, Kaṇṭakāri, Kuṭaja, Musta, Devadāru, Śuṇṭhi and Cavya–this formulation is efficacious in Sannipātaja fever. Śaṭī, Puṣkarmūla, Kaṇṭakāri, Śṛṅgī, Dhanvayāsa, Guḍūcī, Śuṇṭhi, Pāṭhā, Kirātatikta and Kaṭurohinī–these constitute the śatyādi group which alleviates Sannipātaja fever and is commended in cough, cardiac pain, pain in sides, dyspnoea and drowsiness^[58]. Bṛhatī, Kaṇṭakāri, Puṣkarmūla, Bhārgī, Śaṭī, Śṛṅgī, Indrayava, Paṭola and Kaṭurohinī–these constitute the bṛhatyādi group which alleviates Sannipātaja fever and is also useful in complicated cough etc. The physician may also apply the extracts and gruels prepared from the drugs of thirst-alleviating and antipyretic groups mentioned in the chapter of drugs^[59]. If the patient is roughened and the fever does not respond to extracts, emesis, lightening or light diet, he should be treated with ghee. The rough heat causes fever and if there be Vāyu as an associated factor due to roughened heat that is treatable with ghee. All these extracts mixed with ghee should be used for the treatment of fever. They kindle fire and are wholesome. Pippalī, Candana, musta, Uśīra, Kaṭurohinī, Indrayava, Bhūmyāmalakī, Sārivā, Ativiṣa, Śālaparṇi, Drākṣā, Āmalaka, Bilva, Trāyamāṇā and Kaṇṭakāri-ghee cooked with these drugs alleviate the chronic fever quickly. It also overcomes wasting, cough, headache, pain in the chest, halīmaka, discomfort in scapular region and irregular digestion. Vāsā, Guḍūcī, Triphalā, Trāyamāṇā, Yavaśāka-ghee cocked with the decoction of these drugs along with double milk and the paste of Pippalī, musta, Candana, Mṛdvikā, Utpala and Śuṇṭhi is efficacious in chronic fever. Ghee cooked with the decoction of Balā, Gokṣura, Bṛhatī. Pṛśniparṇi, Kaṇṭakāri, Śālaparṇi, nimbi, Parpaṭa, Musta, Trāyamāṇā and Durālabhā along with paste of Bhūmyāmalakī, Śaṭī, Drākṣā, Puṣkarmūla, Medā, and Āmalaka and milk is an excellent antipyretic. It also removes wasting, cough, headache, pain in sides and discomfort in the scapular region. The patients of fever having plenty of impurities should be subjected to timely evacuative therapy, upwards and downwards, to be described in the Kalpasthāna^[60]. Madanaphala and Pippalī or Indrayava or Madhuka should be administered with hot water as an emetic for the alleviation of fever^[61]. In fever, emesis is prescribed with honey-water, sugarcane juice, saline water, wine or saturating drinks. Juice of grapes and Āmalaka fruit acts as purgative as well as antipyretic. Similar is the juice of Āmalaka fried with ghee. One suffering from fever should take powder of Trivṛtā mixed with honey and ghee or decoction of Triphalā adding with honey and ghee, or Āragvadha with milk or grape juice, or Trivṛtā or Trāyamāṇā with milk. One becomes free from fever by taking Harītakī with grapes or grape juice with hot milk. By taking milk boiled with pañcamūlā (the smaller five roots) one suffering from fever becomes free from cough, dyspnoea, headache, pain in sides and chronic fever^[62]. Likewise, by taking milk boiled with Eraṇḍa roots one becomes free from fever associated with cutting pain in the abdomen. Similar is the effect of the milk boiled with tender fruits of Bilva. Milk boiled with Gokṣura, Balā, Kaṇṭakāri, jaggery and Śuṇṭhi alleviates retention of faeces and urine, oedema and fever. Milk boiled with Śuṇṭhi, Mṛdvikā and Kharjūra and added with ghee, honey and sugar alleviate thirst and fever. Even milk alone boiled with four times water is efficacious in fever. The fresh warm milk overcomes the fever caused by Vāta and pitta quickly. Milk is an excellent pacifier of all types of chronic fever. That should be taken hot or cold and boiled with respective drugs (according to the condition of the patient)^[63]. According to Rasendrasāra Sangraha fever should be treated by taking equal quantities of Śuddha Pārada, Śuddha Gandhaka, Śuddha Hiṅgula and Śuddha jayapāla seeds^[64]. Śuddha vatsanābhi, Trikaṭu, Musta, Haridrā, Nimbi patra, and Viḍaṅga are effective^[65]. 12 gms. each of Swarṇa bhasma, Swarṇa sindūra, Loha bhasma, Roupya bhasma, Mṛgāṇḍaja, Jāti phala, Jātikoṣa, Lavaṅga, Gokṣura, Karpūra, Abhraka bhasma, Twak, Muṣali, Śuddha haratāla are taken^[66]. Fever can be categorized into low moderate and high groups. High fever may cause brain injury. The symptoms include immune complex dysfunction, infectious, and West Nile encephalitis^[67].

If the impurity is located in Pakvāśaya (colon), one should apply the non-unctuous and unctuous enema useful in fever which will be described in the Siddhisthāna (action on successful management). Paṭola leaves, Nimbi leave, Uśīra, Āragvadha, Hrībera, Rohiṇī, Tiktā, Gokṣura Madanaphala, Śālaparṇi and Balā–all together should be boiled in half-water milk, till milk remains. This added with honey and ghee along with paste of Madana, musta, Pippalī, Madhuka and Kuṭaja should be used as an antipyretic enema. After the passage is cleansed, impurity is removed, dhātus become cheerful, body-ache goes away, and organs become light the patient becomes free from fever quickly. Similarly, the fluid for enema may be prepared with Āragvadha, Uśīra, Madanaphala and four Parṇinīs (Śālaparṇi, Pṛśniparṇi, Mudgaparṇi and Māṣaparṇi) which is added with the paste of Priyaṅgu, Madana, Musta, Śatāhvā, Madhuyaṣṭikā, ghee, jaggery and honey. This makes an excellent antipyretic enema. Guḍūcī, Trāyamāṇā, Candana, Madhuka, Vāsā, Śālaparṇi, Balā, Pṛśniparṇi and Madana-all together should be boiled to decoction with the soup of the meat of wild animals. The paste of Pippalī, Madana, Musta and Madhuka along with a bit of salt, honey and ghee should be added to it. This makes an antipyretic non-unctuous enema which also provides strength, sweating and relish. Jīvantī, Madhuka, Medā, Pippalī, Madana, Vacā, Ṛddhi, Rāsnā, Balā, Śuṇṭhi, Śatapuṣpa, Śatāvarī–all these are pounded together and boiled with milk, water, ghee and oil. This unctuous enema is antipyretic. The fatty substance cooked with Paṭola, nimbi, guḍūcī, Madhuka and Madana makes an antipyretic unctuous enema. The fatty substance cooked with Candana, Aguru, Kāṣmarya, Paṭola, Madhuka and Utpala makes an excellent unctuous enema. Whatever drugs for head evacuation are mentioned in the chapter of drugs and the same context in the section of Vimāna should be used properly in case of fever, if necessary^[68]. The oil, useful as snuff (Aṇu-tail) and the smoking sticks described in the chapter on the quantity of diet may be applied in fever too. Considering the cold or the hot character of the two types of fever, massage, anointing and sprinklings should be applied as desired. In case of the fever with a burning sensation, the physician should prescribe medicated ghee washed a hundred times and Candanādi taila for massage. In all the types of chronic fever, intake of ghee is beneficial. This ghee may, however, be prepared by boiling with such drugs as would help to alleviate the particular doṣa involved. Vāta is alleviated by ghee due to the latter's unctuousness, Kapha due to the method of preparation with drugs like those having pungent and bitter tastes, which alleviate Kapha and pitta and hyperpyrexia due to coldness. Thus, as water is useful for things burnt with fire, so also ghee is beneficial in all types of chronic fever^[69]. Candanādya oil prepared from Candana, Bhadraśrī, Kālānusārya, Kālīyaka, Padmā, Padmaka, Uśīra, Sārivā, Madhuka, Prapauṇḍarīka, Nāgakeśara, Udīcya, Vanya, Padma, Utpala, Nalina, Kumuda, Saungandhika, Puṇḍrīka, Śatapatra, Bisa, Mṛṇāla, Śāluka, Śaivāla, Kaśeruka, Anantā, Kuśa, Kāśa, Ikṣvu, Darbha, Śara, Nala, Śāli (roots of these seven drugs), Jambū, Vetasa, Vānīra, Gundra, Kakubha, Asana, Aśvakarṇa, Syandana, Vātapotha, Śāla, Tāla, Dhava, Tiniśa, Khadira, Kadara, Kadamba, Kāṣmarya (fruit), Sarja, Plakṣa, Vaṭa, Kapītana, Udumvara, Aśvattha, Nyagrodha, Dhātakī, Dūrvā, Itkaṭa, Śṛṅgāṭaka, Mañjiṣṭhā, Jyotiṣmatī, Puṣkarabīja, Krauncādana, Badarī, Kovidāra, Kadalī, Saṃvartaka, Ariṣṭa, Śataparvā, Śītakumbhikā, Śatāvarī, Śrīparṇī, Śrāvaṇī, Mahāśrāvaṇī, rohiṇī, Śītapāki, Odanapāki, Kālā, Balā, Payasyā, Vidārī, Jīvaka, Ṛṣabhaka, Medā, Mahāmedā, Madhurasā, Ṛṣyaproktā, Tṛṇaśūnya, Mocarasa, Āṭarūṣka, Bakula, Kuṭaja, Paṭola, Nimbi, Śālmali, Nārikela, Kharjūra, Mṛdvikā, Priyāla, Priyaṅgu, Dhanvana, Ātmaguptā and other śītavīrya drugs which are available should be boiled and made into decoction. Oil half the quantity of the decoction should be cooked with the above decoction along with double the quantity of milk and the paste of the same drugs. By massage, this oil alleviates the hot fever quickly. These very drugs pounded coarsely and well-cooked should be applied as an appointment. With the same drugs, boiled and cooled water should be used for bathing and sprinkling^[70]. Sprinkling and bath with honey, sour gruel, milk, curd, ghee and water alleviate the hot fever quickly due to being cold in touch^[71].

One suffering from burning sensation should lie down comfortably on the bed covered with the cold leaves of Puṣkara, lotus and water lily, banana and clean silk cloth cooled with sandal water or in a water-cooled chamber or a room sprinkled with cold water. He should also have the pleasant contact of gold, conch, coral, jewels and pearls cooled with sandal water. He should be fanned with garlands, flowers, blue water lily or lotus and other various fans carrying cool air and showering sandal water. Rivers, tanks, lotus leaves and clean ponds which pacify burning sensation, thirst, malaise and fever should be used for bath. Western doctors also arrange for bathing in case of fever^[72]. Such persons should be entertained with passionate movements by charming and favourite women pasted with sandals and wearing jewels and pearls. Cold food and drinks, gardens, breeze and moon-rays pacify the fever with a burning sensation^[73]. The remedial measures will mention things like massage etc., for the patients of fever desiring heat. Aguru, Kuṣṭha, Tagara, Patra, Nalada, Śaileya, Dhyāmaka, Hareṇuka, Sthauṇeyaka, Kṣemaka, Elā, Varaṅga, Dala, Pura, Tamālapatra, Bhūtika, Rohiṣa, Sarala, Śallakī, Devadāru, Agnimantha, Bilva, Śyonāka, Kāṣmarya, Pāṭalā, Punarṇavā, Vṛścira, Kaṇṭakāri, Bṛhatī, Śālaparṇi, Pṛśniparṇi, Mudgaparṇi, Māṣaparṇi, Gokṣura, Eraṇḍa, Śobhāñjanaka, Varuṇa, Arka, Cirabilva, Tilvaka, Śaṭī, Puṣkarmūla, Gandira, Arubūka, Pattūra, Akṣiva, Aśmantaka, Śigru, Mātuluṅga, Piluka, Mūlakaparṇi, Tilaparṇi, Pituparṇi, Meṣaśṛṅgī, Hiṃsrā, Dantaśaṭha, Airāvataka, Bhallātaka, Kāṇḍira, Ātmaguptā, Kākāṇḍa, Ekaiṣikā, Karañja, Dhānyaka, Ajamodā, Pṛthvikā, Sumukha, Surasa, Kuṭheraka, Kālamālaka, Parṇāsa, Kṣavaka, Phaṇijjhaka, Bhūstṛṇa, Śṛṅgabera, Pippalī, Sarṣapa, Aśvangadhā, Rāsnā, Ruhā, Rohā, Vacā, Balā, Atibalā, Guḍūcī, Śatapuṣpa, Śītavallī, Nākulī, Gandhanākulī, Śvetā, Jyotiṣmatī, Citraka, Adhyaṇḍā, Amlacāṅgerī, Tila, Badara, Kulattha, Māṣa and other such Uṣṇavīrya drugs, as available, should be made into decoction. With this decoction and the paste of the same drugs dissolved in surā (wine), Sauvīraka, Tuṣodaka (types of vinegar), Maireya, medaka, Dadhimaṇḍa, Āranala and Kaṭvara (types of sour gruel), oil in the quantity of 2.56 kg should be cooked. With this lukewarm oil the patient of fever desiring heat should be massaged, thus the cold fever subsides. The same very drugs pounded finely and in lukewarm condition should be anointed on the body of the patient. Lukewarm water boiled with these drugs should be used for bath and sprinkling to pacify the cold fever^[74].

The thirteen types of fomentation are saṅkara, prastara, nāḍī, pariṣeka, avagāhana, jentāka, aśmaghana, karṣū, kuṭī, bhū, kumbhikā, kūpa, and holāka should be applied by the physician according to dose and time to alleviate the cold fever^[75]. The same hut, the cot and the coverings along with dense incense of Aguru pacify the cold fever. Young women with well-constituted Diaphoretic food and drinks and those which alleviate Vāta and Kapha overcome cold fever if applied considering the comparative strength of the above two doṣas in combination. Lightning is not indicated in the fever caused by vāta, exertion, injury and the chronic one. These cases should be managed with pacificator measures. As the doṣas having thrown out the gastric fire and circulating along the rasa produce fever, the power of digestion diminishes. As even the inflamed fire despite fuel does not cook the rice well in the cooking vessel because of being diverted outside due to wind, the digestive fire thrown out of its normal location by doṣas in the patient of fever cannot digest the food taken or digests light food with difficulty. Keeping this in view, the management with lightning etc. has been prescribed. Doṣas entered into the seven dhātus get digested in a week that is why the fever is said to be mature on the eighth day. The patient having diminished Agni and aggravated doṣas are left suddenly by the vital breath that suffers for long if he takes food particularly some heavy one. Because of this reason the wise physician should not prescribe a diet in large quantities of excessively heavy or fatty from the start of the fever even in vātika fever. In vātika fever, if there is no association of any other doṣa, massage etc., should be applied to ignore the usual procedure. Thereafter he should be given medicinal extract and then diet with meat-soup. Other measures efficacious in a chronic fever should also be adopted. In patients who are constitutionally predominant in Kapha and deficient in vāta if fever comes with abundant Kapha and low fever, it does not mature even in a week due to mild Agni. Hence, he should be managed with the said lightening, light diet etc., till ten days and thereafter with medicinal extracts. Fevers which are associated with Āma, or are caused by Kapha or Kapha-pitta should be subjected to lightening measures^[76]. Fever caused by Kapha, pitta, and vāta should be treated with emesis, purgation and enema respectively. In cases of fever caused by dual or aggregated doṣas, one should prescribe proper drugs considering their comparative predominance or equality. The Sannipātaja fever should be treated by increasing the dismissed doṣas, decreasing the aggravated ones and keeping the condition of the location of Kapha (Āmāśaya) in view. At the end of the aggregated fever, severe swelling occurs at the root of the ears from which one rarely survives. It should be treated with prompt blood-letting, intake of ghee, anointing, snuffing, and gargles which alleviate Kapha and pitta. Fever which does not subside by treatment with cold, hot, unctuous, non-unctuous etc., and has entered into Śākhā (rakta etc.) is treated with bloodletting. Fever arising due to erysipelas, injury and eruptions, is treated first with the intake of ghee if it is not predominant in Kapha and pitta. Chronic fever continues because of the debility of bodily dhātus; hence it should be managed with the diet promoting strength and body-bulk. The usual procedure should be left in tertian and quartan fever because there is often extrinsic factor associated with the intermittent fever. Viṣama-jvara which is predominant in vāta should be treated with ghee, enema–non-unctuous and unctuous–and fatty and hot food and drinks. The predominant in pitta should be treated with purgation, milk, and medicated ghee, bitter and cold drugs. Viṣama-jvara predominant in Kapha should be treated with emesis, digestives, rough diet, lightening measures, astringent and hot drugs^[77].

The formulations which alleviate the intermittent fever shall mention. They should be administered by the wise physician after considering doṣa etc. Concentrated wine for drink, cock, partridge and peacock in the diet should be used in intermittent fever. The patient should take Ṣaṭpala ghṛta or Harītakī, or decoction of Triphalā or juice of guḍūcī, or decoction of Nilinī, Ajagandhā, Trivṛtā and Kaṭurohinī, at the advent of fever, after unction and fomentation or he should take the large dose of ghee and then vomit it, or after taking plenty of meal he should vomit, or after a good meal, he should take plenty of wine and then go to bed. In intermittent fever, one should prescribe non-unctuous or sustaining enemas or the patient should take cat's faces along with milk on the same day, or the bull's faces added with rock-salt along with curd-scum or wine. The use of Pippalī, Triphalā, curd, buttermilk, Pañcagavya ghṛta and milk is commended in intermittent fever. The fever is prevented by wearing gems, auspicious herbs and poison and also by intake of anti-poison drugs. One, worshipping devotedly Lord Śiva along with Pārvatī, the congregation of mothers and attendants, is relieved quickly of intermittent fever. One is freed from all types of fever by eulogizing Viṣṇu thousandheaded, master of mobile and immobile and omnipresent with thousand names. One overcomes fever by worshipping with sacrifices Brahma, Aśvins, Indra, Agni, Himalaya, Gaṅgā and congregation of Maruts^[78]. One is relieved of fever by devotion to parents, respect to teachers, celibacy, penance, truthfulness, observance of rules, repetition of the mantra, an offering of the oblation, hearing of Vedas and visiting saintly persons^[79]. It has been said in the Aṣṭāṅga Hṛdayaṃ, if the Viṣama-fever is not calmed, then the Acupuncture should be according to doṣa^[80]. In fever located in rasa one should prescribe emesis and fasting; in that located in rakta blood-letting and anointing along with pacificators measures; purgation with fasting is wholesome in fever located in māṃsa and medas. In that located in asthi and majjā, a non-unctuous enema should be administered. Fever caused by cursing, exorcism, and contact of evil spirits is treated with divine therapy. Fever caused by injury is cured by intake and massage of ghee, blood-letting, suitable wines and food consisting of meat-soup and rice. Fever with the hardness of bowels in those addicted to wines should be treated with wines and food with meat soup. Fever caused by wounds and ulcers gets controlled by the treatment of the above causes. Fever caused by passion, grief and fear is pacified by soothing talks, meeting with the beloved, alleviation of Vāyu and inducing exhilaration. Fever caused by anger is subsided by liked and favourite objects, measures alleviating pitta and soothing words. Passion overcomes the fever caused by anger and vice versa. Both alleviate the fever caused by fear and grief. One, who gets fever by thinking over its rising time, should be detracted with favourite and surprising objects^[81].

During a remission of fever, the patient groans, vomits, moves, respires, becomes pale, has perspired organ, trembles, faints frequently, has delirium, the whole body being hot or cold, becomes unconscious and as if filled with anger during the rise of fever, passes faeces with impurity and sound, liquid and with force. These should be taken as signs of the remission of fever^[82]. That is what doctors called the collapse^[83]. In case the patient has profuse morbidity and the fever is acute and high, the remission occurs by the crisis due to proper management and maturation of doṣas. On the other hand, if the fever is chronic, the fever having risen due to doṣa slowly comes down. The patient should be taken as free from fever when exhaustion and pyrexia are gone, there is no stress, senses are sound, and the psyche has revived normalcy^[84]. during fever or convalescence, the patient should avoid heavy, unsuitable and unwholesome food and drinks. He should also abstain from sexual interaction, over-work, bath and excessive eating. Hence, fever recedes and thereafter does not relapse^[85]. During recuperation, one should not do physical activity, sexual intercourse, bath and walking till he regains strength^[86]. According to Bhāvaprakāśa, in case of fever, the drugs should be applied after seven days of rheumatic fever, after ten days of biliary fever and after twelve days of mucous fever^[87]. Different specialists suggest differently about the treatment of the fever^[88].

Taking this avoidable food and activities during improvement before recovering normal strength, the fever relapses. It also deteriorates even with slight negligence in cases where fever comes down though the doṣas are not reduced correctly. The worsened fever kills the patient suffering since long, weakened and with poor Agni in a short time. Sometimes doṣas get matured in successive dhātus, thus they do not generate fever but cause harm to the body. They generate nervous expressions, swelling, paleness, anorexia, malaise, itching, rashes, pimples and mildness of appetite. Likewise, other cured disorders too relapse on a slight unwholesome activity if doṣas are not eliminated properly. Hence even after the fever subsides, doṣas should be eliminated or pacified according to condition, strength and vitality (of the patient). In such cases, evacuation with mild measures, light vegetable soup, sustaining enemas, and meat-soups of the wild animals are wholesome^[89]. Massage, anointing, bath, incense, collyrium, bitter ghee is prescribed in relapsed fever. If the fever relapses due to heavy, channel-blocking and inappropriate diet, management with lightning and hot therapy as mentioned above may be done. Kirātatikta, kuṭakī, musta, Parpaṭaka, and Guḍūcī–a decoction of these drugs together, if taken regularly, destroys the relapsing fever^[90]. The wise physician, considering the managing of fever, should handle the case according to condition. Fever is the king of all diseases, destroyer of all creatures and severe, hence a physician should be especially cautious in treating it^[91].

Footnotes and references:

[1]:

Suśruta Saṃhitā of Maharṣi Suśruta Vol. III, Anant Ram Sharma (ed.), Varanasi, Chaukhamba Surbharati Prakashan, 2018, p. 239.

[2]:

sarvarogāgrajo | (CS. Cikitsā–III.4); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 108.

[3]:

dehendriyamanastāpī | (CS. Cikitsā–III.4); Ibid.

[4]:

mithyāhāravihārābhyāṃ doṣā hyāmāśayāśrayāḥ |
bahirnirasya koṣṭhāgniṃ jvaravāḥ syu rasānugāḥ || (Yogaratnākara–Jvara lakṣaṇam–2); Yogaratnākara with ‘Vaidyaprabha’ Hindi Commentary, trans. Indradev Tripathi & Daya Shankar Tripathi, Varanasi, Chowkhamba Krishnadas Academy, 2013, p. 143.

[5]:

CS. Cikitsā–III.11; R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 110.

[6]:

jvarastukhalumaheśvarakopaprabhavaḥ, sarvaprāṇabhṛtāṃprāṇaharo, dehendriyamanastāpakaraḥ, prajñābalavarṇaharṣotsāhahrāsakaraḥ, śramaklamamohahāroparodhasaṃjananaḥ, jvarayatiśarīṇāṇītijvaraḥ, nānyevyādhayastathādāruṇābahūpadravāduścikittsyāśca yathā'yam |sasarvarogādhipati:, nānātiryagyoniṣucabahuvidhaiḥśabdairabhidhīyate | sarvaiprāṇabhṛtaḥsajvarā evamriyanteca; sa mahāmohaḥ, tenābhibhūtāḥprāgdaihikaṃ dehinaḥkarmakiṃ cidapinasmaranti, sarvaprāṇabhṛtāṃcajvaraevānteprāṇānādatte ||(CS. –Nidānasthāna–I.35); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 29.

[7]:

CS. -Cikitsāsthāna–III.15-25; R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. II, Varanasi, Chowkhamba Sanskrit Series Office, 2017, pp. 113-115.

[8]:

dakṣāpamānasaṅ kuddharudraniḥ śvāsasambhavaḥ |
jvaro'ṣṭadhā pṛthagdvandvasaṅghātāgantujaḥ smṛtaḥ || (Mā. Ni. –II /Jvara Nidānam/1); Mādhava-Nidāna of Mādhavakara with the Commentary Madhukoṣa by Vijayarakṣita & Śrīkaṇṭhadatta, Brahmanand Tripathi(ed.), trans. Kanjiv Lochan, Varanasi, Chaukhamba Surbharati Prakashan, 2018, pp. 1-1067.

[9]:

atha khalvaṣṭābhyaḥ kāraṇebhyo jvaraḥ saṃjāyate manuṣyaṇāṃ; tadyathā-vātāt, pittāt, kaphāt, vātapittābhyāṃ, vātakaphābhyāṃ, pittakapābhyāṃ, vātapittakaphe bhyaḥ, āgantoraṣṭamāt kāraṇāt || (CS. Nidānasthāna–I.17); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. II, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p.17.

[10]:

jvaro rogapatiḥ pāpmā mṛtyurojośano'ntakaḥ |
krodho dakṣādhvaradhvaṃsī rudrordhvanayanodbhavaḥ ||
janmāntayormohamayaḥ santāpātmā'pacārajaḥ |
vividhairnāmabhiḥ krū ro nānāyoniṣu vartate || (Aṣṭā. H. –Nidānasthāna-2/1-2); Aṣṭāṅga Hṛdayaṃ of Vāgbhaṭṭa Vol. II, trans. K. R. Srikantha Murthy, Varanasi, Chaukhambha Krishnadas Academy, 2018, p.11.

[11]:

In CS. Vimana–III.24, that at the end of the Satya-yuga, some people got heaviness in the bodies due to overindulgence. They suffered from fatigue because of the heaviness of the body. Fatigue gave rise to laziness and laziness made them accumulate things. This accumulation led to the attachment for these things and attachment resulted in greed. It is because of this attachment (Parigraha) etc., all diseases took their origin at the end of Satya yuga and in subsequent yugas. This has been referred to at the end of Satya-yuga and in subsequent yugas. This has been referred to in the present verse by the term ‘Parigraha’.; R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 1112.

[12]:

mukhavairasyaṃ, gurugāatratvam, anannābhilāṣaḥ, cakṣuṣorākulatvam........(CS. Nidānasthāna–I.33); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. II, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 28.

[13]:

aṣṭābhiḥ kāraṇairjvaraḥ sañjāyate manuṣyāṇāṃ pṛthagdoṣaiḥ saṃsṛṣṭaiḥ sannipatitairāgantunā ca || (Aṣṭā. S. –Nidānasthāna- 2/2); Aṣṭāṅga Saṃgraha of Vāgbhaṭṭa Vol. II, trans. K. R. Srikantha Murthy, Varanasi, Chaukhambha Orientalia, 2018, p.148.

[14]:

tasyemāni pūrvarūpāṇi mukhavairasyamannanabhilāṣo gurugātratvamālasyamalpaprāṇatā gatiskhalanaṃ nidrādhikyamaratirasūyā hitopadeśeṣu pradveṣo bāleṣumadhureṣu ca bhakṣyeṣvamlalavaṇakaṭukābhinandanamavipāke 'ṅgamardaścakṣuṣorākulatvaṃ sāśrutā jṛmbhā vināmaḥ klamo romaharṣaḥ śabdānalāmbuśītavātacchāyātapeṣvakasmādicchādveṣau ca | tadanantaraṃ vyaktībhāvo jvarasyeti | bhavati cātra || (Aṣṭā. S. –Nidānasthāna-2/4); Aṣṭāṅga Saṃgraha of Vāgbhaṭṭa Vol. II, trans. K. R.

[15]:

svedāvarodhaḥ santāpaḥ sarvāṅgagrahaṇaṃ tathā |
vikārā yugapadyasmin jvaraḥ sa parikīrtitaḥ || (Suśruta Uttar–39.13) Suśruta Saṃhitā of Maharṣi Suśruta Vol. III, Anant Ram Sharma (ed.), Varanasi, Chaukhamba Surbharati Prakashan, 2018, p. 241.

[16]:

ṛtvahorātra doṣāṇāṃ manasaśca balābalāt |
kālamarthavaśāccaiva jvarastaṃ taṃ prapadyate || (CS. Cikitsāsthāna–III.75); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p.134.

[17]:

CS. –III.26-36; Caraka Saṃhitā Vol. II, trans. P.V. Sharma, Varanasi, Chaukhambha Orientalia, 1998, pp. 54-55.

[18]:

Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka- Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, pp. 213- 214.

[19]:

Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka- Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, pp. 216.

[20]:

The shelter of Santata Fever is air, bile, phlegm, blood, flesh, fat, bone, marrow, sperm, stool and urine.; Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka- Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, pp. 217- 218.

[21]:

CS. –III.19-32; Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka-Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, pp. 215-218.

[22]:

anyed yuṣkaṃ jvaraṃ pratidinaṃ dinaṃ tṛtīyakaḥ |
dinadvayaṃ yo viśramya pratyeti sa caturthakaḥ || (CS. Cikitsāsthāna–III.67); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p.130.

[23]:

prāyaśaḥ sannipātena dṛṣṭaḥ pañcavidhau jvaraḥ |
sannipāte tu yo bhūyān sa doṣaḥ parikīrtitaḥ || (CS. Cikitsāsthāna–III.74); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p.133.

[24]:

Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka- Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, p. 220.

[25]:

CS. –III.76-83; Caraka Saṃhitā Vol. II, trans. P.V. Sharma, Varanasi, Chaukhambha Orientalia, 1998, pp. 59-60.

[26]:

śirorukparvvaṇāṃbhedodāhoroyāṃpraharṣaṇam ||
kaṇṭhāsyaśoṣovamathustṛṣṇāmūrcchābhramo'ruciḥ ||
svapnanāśo'tivāgjṛmbhāvātapittajvarākṛ tiḥ | (CS. Cikitsāsthāna–III. 85-86); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 136.

[27]:

Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka- Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, p. 221.

[28]:

śītakogauravaṃ tandrā staimityaṃ parvaṇāṃ ca ruk ||
śiregrahaḥ pratiśyāyaḥ kāsaḥ svedāpravartanam |
santāpo madhyavegaśca vātaśleṣmajvarākṛ tiḥ || (CS. Cikitsāsthāna–III. 86-87); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 136.

[29]:

muhurdāho muhuḥ śītaṃ svedastambho muhurmuhuḥ |
mohaḥ kāso'rucistṛṣṇā śleṣmapittapravartanam ||
liptatiktāsvatā tandrā śleṣmapittajvarākṛ ti: | (CS. Cikitsāsthāna–III. 88-89); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 136.

[30]:

CS. –III.84-88; Caraka Saṃhitā Vol. II, trans. P.V. Sharma, Varanasi, Chaukhambha Orientalia, 1998, p. 60.

[31]:

sūtrasthane bhagavatā nirdiṣṭo dvividho jvaraḥ |
punaraṣṭavidhaḥ prokto nidāne tattvadarśinā || (Kāśya. S. -Cikitsāsthāna–6/4); Kāśyapa Saṃhitā by Vṛddha Jīvaka with the Vidyotani Hindi Commentary, trans. Satyapāla Bhiṣgāchārya, Varanasi, Chaukhambha Sanskrit Sansthan, 2018, p. 137.

[32]:

viṣamārambhavisargitvam, ūṣmaṇo vaiṣamyaṃ, tīvratanubhāvānavasthanāni............ (CS. Nidānasthāna–I.19-21); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. II, Varanasi, Chowkhamba Sanskrit Series Office, 2017, pp. 18-21.

[33]:

yugapadeva ke vale śarīre jvarasyābhyāgamanamabhivṛddhirvā bhuktasya........ (CS. Nidānasthāna–I.22-24); R. K. Sharma &Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. II, Varanasi, Chowkhamba Sanskrit Series Office, 2017, pp. 22-23.

[34]:

snigdhagurumadhurapicchilśītāmlalavaṇadivāsvapnaharṣāvyāyāmebhyo.........(CS. Nidānasthāna–I.25-27); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. II, Varanasi, Chowkhamba Sanskrit Series Office, 2017, pp. 23-24.

[35]:

CS. –III.89-106; Caraka Saṃhitā Vol. II, trans. P.V. Sharma, Varanasi, Chaukhambha Orientalia, 1998, pp. 61-62.

[36]:

kṣaṇe dāhaḥ kṣaṇe śītamasthisandhiśirorujā ||
sāsrāve kaluṣe rakte..............................
...... cirāt pakaśca doṣāṇāṃ sannipātajvarākṛ tiḥ || (CS. Cikitsāsthāna–III.103-109; Caraka Saṃhitā Vol. II, trans. P.V. Sharma, Varanasi, Chaukhambha Orientalia, 1998, p. 62.

[37]:

sarvajo lakṣaṇaiḥ sarvairdāho'tra ca muhurmuhuḥ |
tadvacchītaṃ mahānidrā divā jāgaraṇaṃ niśi ||
sadā vā naiva vā nidrā....................
.... sannipātamabhinyāsaṃ taṃ brūyācca hṛtaujasam || pittādhike 'dhikam || (Aṣṭā. H. –Nidānasthāna-1/27-33); Aṣṭāṅga Hṛdayaṃ of Vāgbhaṭṭa Vol. II, trans. K. R. Srikantha Murthy, Varanasi, Chaukhambha Krishnadas Academy, 2018, pp. 16-17.

[38]:

Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka- Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, p. 226.

[39]:

Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka- Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, pp. 226- 227.

[40]:

krameṇa vṛddhān rasagandhahiṅ gulān naikumbhabījānyatha dantivāriṇā |
piṣṭvā'sya guñjā'bhinavajvarāpahājalena cārdrā sitayā prayojitā ||
viṣaṃ trikaṭukaṃ mustaṃ haridrā nimbapatrakam |
viḍaṅgamaṣṭamaṃ cūrṇa chāgamūtraiḥ samaṃ samam |
caṇakābhā vaṭī kāryyāṃ syāt jayā yogavāhikā ||
svarṇa svarṇasindū raṃ lauhaṃ tāraṃ mṛgāṇḍajām |
jātīphalaṃ jātīkoṣaṃ lavaṅgaca trikaṇṭakam ||
karpūraṃ gaganañcaiva cocaṃ muṣalatālakam |
pratyekaṃ karṣamānantu turaṅgañca dvikārṣikam || (Śāraṅg. S. –I/7/2-6); Śāraṅgadhara-Saṃhitā: A Treatise on Ayurveda by Śāraṅgadhara, trans. K. R. Srikantha Murthy, Varanasi, Chaukhambha Orientalia, 2017, pp. 31-32.

[41]:

Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka- Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, p. 227.

[42]:

CS. –III.109-113; R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 141-142.

[43]:

abhighātābhiṣaṅgābhicārābhiśāpebhya āgunturhi vyathāpūrvo'ṣṭamo jvaro bhavati | sakiṃ citkālamāgantuḥ ke valo bhūtvā paścāddoṣairanubadhyate | tatrābhighāto vāyunā duṣṭaśoṇitādhiṣṭhānena, abhiṣaṅgajaḥ punarvātapittabhyām, abhicārābhiśāpajau tu sannipātenānubadhyete || matam || (CS. Nidānasthāna–I.30); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. II, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 26.

[44]:

aruciścāvipākaśca gurutvamudarasya ca ||
hṛdayasyāviśuddhiśca tandrā cālasyameva ca |
jvaro'visargī balavān doṣāṇāmapravartanam ||
lālāprasekohṛllāsaḥ..................................
.... malapravṛttirutkleśaḥ pacyamānasya lakṣaṇam | (CS. Cikitsāsthāna–III. 133-136); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 147.

[45]:

kṣut kṣāmatā laghutvaṃ ca gātrāṇāṃ jvaramārdavam ||
doṣapravṛttiraṣṭāho nirāmajvaralakṣaṇam || (CS. Cikitsāsthāna–III. 137); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 148.

[46]:

navajvare divāsvapnasnānābhyaṅgānnamaithunam ||
krodhapravātavyāyāmān kaṣāyāṃśca vivarjayet | (CS. Cikitsāsthāna–III. 138); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 139.

[47]:

CS. –III.114-141; Caraka Saṃhitā Vol. II, trans. P.V. Sharma, Varanasi, Chaukhambha Orientalia, 1998, pp. 63-65.

[48]:

CS. Nidānasthāna -I.36; R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 30.

[49]:

CS. Vimānasthāna -III.48-51; Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya(eds.), Caraka-Samhita–Vol. I, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, p. 24.

[50]:

CS. –III.142-148; R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, pp. 151-154.

[51]:

CS. –III.149-159; Caraka Saṃhitā Vol. II, trans. P.V. Sharma, Varanasi, Chaukhambha Orientalia, 1998, pp. 66-67.

[52]:

CS. –III.160-168; R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 158-164.

[53]:

peyāṃ vā raktaśālīnāṃ pārśvabastiśiroruji ||
śvadaṃṣṭrā kaṇṭakāribhyāṃ siddhāṃ jvaraharāṃ pibet | (CS. Cikitsāsthāna–III. 116); Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya(eds.), Caraka-Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, p. 235.

[54]:

śṛtāṃvidārī gandhādyaidīpaniṃ svedanīṃ naraḥ |
kāsī śvāsī ca hikkā ca yavāgūṃ jvaritaḥ pivet |
vivaddhavarccāḥ sayavāḥ pippalyāmalakai ḥ kṛ tām || (CS. Cikitsāsthāna–III. 118); Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya(eds.), Caraka-Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, p. 236.

[55]:

gharmvāmvu cānupānārthaṃ tṛṣitāya pradāpayet |
madyaṃ vā madyasātmāya yathādoṣaṃ yathāvalam || (CS. Cikitsāsthāna–III. 194); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 171.

[56]:

gurūṣṇastrigdhamadhurān kaṣāyāṃśca navajvare ||
āhārān doṣapaktyarthaṃ prāyaśaḥ parivarjayet | (CS. Cikitsāsthāna–III. 195-196); Caraka Saṃhitā Vol. II with elaborated Vidyotini Hindi Commentary, trans. Kasinatha Pandey & Gorakha Natha Chaturvedi, Varanasi, Chaukhambha Bharati Academy, 2015, p. 148.

[57]:

kaṣāyāḥ śamayantyāśu pañca pañcavidhāñjvarān |
saṃtataṃ satatānyed yustṛtīyakacaturthakān || (CS. Cikitsāsthāna–III. 203); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 178.

[58]:

bṛhatyau vatsakaṃ mustaṃ devadāru mahauṣadham |
kolavallī ca yogo'yaṃ saṃnipātajvarāhaḥ ||
śaṭī puṣkaramūlaṃ............. śvāsatandrāsu śasyate || (CS. Cikitsāsthāna–III. 210-212); Caraka Saṃhitā Vol. II with elaborated Vidyotini Hindi Commentary, trans. Kasinatha Pandey & Gorakha Natha Chaturvedi, Varanasi, Chaukhambha Bharati Academy, 2015, p. 173.

[59]:

CS. -Sūtrasthāna–II-IV; Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya(eds.), Caraka-Samhita–Vol. I, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, pp. 17-35.

[60]:

nava yogāḥ kaṣāyeṣu, mātrāsvaṣṭau, payoghṛte |
pañca, phāṇitacūrṇe dvau ghneye, vartikriyāsu ṣaṭ ||
viṃśatirviṃśatirleha.......... || (CS. Kalpasthāna–I. 28-30); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. VI, Varanasi, Chowkhamba Sanskrit Series Office, 2017, pp. 25-26.

[61]:

According to Cakrapāṇi's commentary, the seed of Madana should be used when there is the aggravation of Kapha, Kaliṅga when there is the aggravation of pitta and Kapha and madhuka when there is a burning sensation. (CS. Cikitsāsthāna–III. 227-233); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 189.

[62]:

kāsācchvāsācchiraḥśūlāt pārśvaśūlāccirajvarāt |
mucyate jvaritaḥ pītvā pañcamūlaśṛtaṃ payaḥ || (CS. Cikitsāsthāna–III. 234); Caraka Saṃhitā Vol. II with elaborated Vidyotini Hindi Commentary, trans. Kasinatha Pandey & Gorakha Natha Chaturvedi, Varanasi, Chaukhambha Bharati Academy, 2015, p. 154.

[63]:

CS. –III.169-239; Caraka Saṃhitā Vol. II, trans. P.V. Sharma, Varanasi, Chaukhambha Orientalia, 1998, pp. 68-75.

[64]:

krameṇa vṛddhān rasagandhahiṅ gulān naikumbhabījānyatha dantivāriṇā |
piṣṭvā'sya guñjā'bhinavajvarāpahājalena cārdrā sitayā prayojitā || (Ras. S. –II/Jvara Cikitsā/1); Ashok D. Satpute, Rasendra Sāra Saṅgraha of Sri. Gopal Krishna, Varanasi, Chowkhamba Krishnadas Academy, 2009, p. 272.

[65]:

viṣaṃ trikaṭukaṃ mustaṃ haridrā nimbapatrakam |
viḍaṅgamaṣṭamaṃ cūrṇa chāgamūtraiḥ samaṃ samam |
caṇakābhā vaṭī kāryyāṃ syāt jayā yogavāhikā || (Ras. S. –II/Jvara Cikitsā/16); Ashok D. Satpute, Rasendra Sāra Saṅgraha of Sri. Gopal Krishna, Varanasi, Chowkhamba Krishnadas Academy, 2009, p. 275.

[66]:

svarṇa svarṇasindū raṃ lauhaṃ tāraṃ mṛgāṇḍajām |
jātīphalaṃ jātīkoṣaṃ lavaṅgaca trikaṇṭakam ||
karpūraṃ gaganañcaiva cocaṃ muṣalatālakam |
pratyekaṃ karṣamānantu turaṅgañca dvikārṣikam || (Ras. S. –II/Jvara Cikitsā/366-367); Ashok D. Satpute, Rasendra Sāra Saṅgraha of Sri. Gopal Krishna, Varanasi, Chowkhamba Krishnadas Academy, 2009, p. 342.

[67]:

Ras. S. –II/Jvara Cikitsā/206-209; Ashok D. Satpute, Rasendra Sāra Saṅgraha of Sri. Gopal Krishna, Varanasi, Chowkhamba Krishnadas Academy, 2009, p. 314-315.

[68]:

apāmārgasya bījāni pippalīrmaricāni |
viḍaṅgānyatha śigrūṇi sarṣapāṃstumburūṇi ||
ajājīṃ cājagandhāṃ............... || (CS. Sūtrasthāna–I. 3-6); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. II, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 63.
śirovirecanadravyāṇi punarāpāmārgapippalīmaricaviḍaṅgaśigruśirīṣatumbarupilvajājyajamodāvārtākīkai lāhareṇu- kāphalāni ca...................... || (CS. Vimānasthāna–VIII.151); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. II, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 307.

[69]:

yathā prajvalitaṃ vesma pariṣiñcati vāriṇā |
narāḥ śāntimabhipretya tathā jīrṇajvare ghṛtam ||
snehadvātaṃ śamayati, śaityat pittaṃ niyacchati |
ghṛtaṃ tulyaguṇaṃ doṣaṃ saṃskārāttu jayet kapham ||
nānyaḥ snehastathā kaścit saṃskāramanuvartate |
yathā sarpirataḥ sarpiḥ sarvasnehottamaṃ matam || (CS. Nidānasthāna–I.38-40); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. II, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 31.

[70]:

CS. –III.240-259; R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 191-195.

[71]:

madhvāranāla-kṣīra-dadhi-ghṛta-salilasekāvagāhāśca |
sadyo dāhajvaramapanayanti śītasparśatvāt || (CS. Cikitsāsthāna–III. 259); Caraka Saṃhitā Vol. II with elaborated Vidyotini Hindi Commentary, trans. Kasinatha Pandey & Gorakha Natha Chaturvedi, Varanasi, Chaukhambha Bharati Academy, 2015, p. 158.

[72]:

Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka- Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, p. 246.

[73]:

śītāni cānnapānāni śītānyupavanāni ca |
vāyavaścandrapādāśca śītā dāhajvarāpahāḥ || (CS. Cikitsāsthāna–III. 266); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 197.

[74]:

CS. Cikitsāsthāna -III.260-267; Caraka Saṃhitā Vol. II, trans. P.V. Sharma, Varanasi, Chaukhambha Orientalia, 1998, pp. 77-79.

[75]:

saṅkaraḥ prastaro nāḍī pariṣeko'vagāhanam |
jentākośmaghanaḥ karṣūḥ kuṭī bhūḥ kumbhikai va ca ||
kūpo holāka ityete svedayanti trayodaśa |
tān yathāvat pravakṣyāmi sarvānevānupūrvaśaḥ || (CS. Sūtrasthāna–XIV. 39-40); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. I, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 276.

[76]:

laghūṣṇatīkṣṇaviśadaṃ rūkṣaṃ sūkṣmaṃ kharaṃ saram ||
kaṭhinaṃ caiva yadravyaṃ prāyastallaṅghanaṃ smṛtam ||
catuṣprakārā saṃśuddhiḥ pipāsā mārutātapau |
pācanānyupavāsaśca vyāyāmaśceti laṅghanam || (CS. Sūtrasthāna–XXII. 5, 11); Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka-Samhita–Vol. I, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, pp. 179-180.

[77]:

CS. –III.268-295; R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 200-210.

[78]:

somaṃ sānucaraṃ devaṃ samātṛgaṇamīśvaram ||
pūjayan prayataḥ śīghraṃ mucyate viṣamajvarāt |
viṣṇuṃ sahasramūrdhānaṃ carācarapatiṃ vibhum ||
stuvannāmasahasreṇa jvarān sarvānapohati |
brahmāṇamaśvināvindraṃ hutabhakṣaṃ himācalam ||
gaṅgāṃ marudgaṇāṃśceṣṭyā pūjayañjayati jvarān | (CS. Cikitsāsthāna–III. 310-313); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, pp. 213-214.

[79]:

bhaktyā mātuḥ pituścaiva gurūṇāṃ pūjanena ca ||
brahmacaryeṇa tapasā satyena niyamena ca |
japahomapradānena vedānāṃ śravaṇena ca || (CS. Cikitsāsthāna–III. 313-314); Caraka Saṃhitā Vol. II with elaborated Vidyotini Hindi Commentary, trans. Kasinatha Pandey & Gorakha Natha Chaturvedi, Varanasi, Chaukhambha Bharati Academy, 2015, p. 171.

[80]:

yathāsvaṃ ca sirāṃ vidhyedaśāntau viṣamajvare | (Aṣṭā. H. –Nidānasthāna-1/166); Aṣṭāṅga Hṛdayaṃ of Vāgbhaṭṭa Vol. II, trans. K. R. Srikantha Murthy, Varanasi, Chaukhambha Krishnadas Academy, 2018, p. 203.

[81]:

(CS. -Cikitsāsthāna–III. 217-224); Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka-Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, pp. 254-255.

[82]:

jvarapramokṣe puruṣaḥ kūjan vamati ceṣṭate |
śvasanvivarṇaḥ svinnāṅgo vepate līyate muhuḥ ||
pralapatyuṣṇasarvāṅgaḥ śītāṅgaśca bhavatyapi |
visaṃjño jvaravegārtaḥ sakrodha iva vīkṣyate ||
sadoṣaśabdaṃ ca śakṛ dravaṃ sravati vegavat |
liṅgānyetāni jānīyājjvaramokṣe vicakṣaṇaḥ || (CS. Cikitsāsthāna–III. 324-326); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 216.

[83]:

Baidyacharya Kalikinkar Sensarma & Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka- Samhita–Vol. II, trans. Kabiraj Jasodanandan Sirkar, Kolkata, Deepayan Publication, 2013, p. 256.

[84]:

vigataklamasaṃtāpamavyathaṃ vimalendriyam |
yuktaṃ prakṛ tisattvena vidyāt puruṣamajvaram || (CS. Cikitsāsthāna–III. 329); Caraka Saṃhitā Vol. II with elaborated Vidyotini Hindi Commentary, trans. Kasinatha Pandey & Gorakha Natha Chaturvedi, Varanasi, Chaukhambha Bharati Academy, 2015, p. 173.

[85]:

sajvaro jvaramuktaśca vidāhīni gurūṇi ca |
asātmyānyannapānāni viruddhāni ca varjayet ||
vyavāyamaticiṣṭāśca snānamatyaśanāni ca |
tathā jvaraḥ śamaṃ yāti praśāntau jāyate na ca ||
vyāyāmaṃ ca vyavāyaṃ ca snānaṃ caṅ kramaṇāni ca |
jvaramukto na sevate yāvanna balavān bhavet || (CS. Cikitsāsthāna–III. 330-332); R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 217.

[86]:

CS. –III.296-332; Caraka Saṃhitā Vol. II, trans. P.V. Sharma, Varanasi, Chaukhambha Orientalia, 1998, pp. 82-85.

[87]:

vātike saptarātreṇa daśarātreṇa paittike |
ślaiṣmike dvādaśāheṇa jvare yuñjīta bheṣajam ||
saptarātreṇa ityatra rātriśabdo divasasyopalakṣakaḥ || Bhāvaprakāśa by Bhāvamiśra Vol. II, trans. Kalishachandra Sengupta, Vaidyacarya Kalikinkara Senasharma & Ayurvedacharya Satya Shekhara Bhattyacharya (eds.), Kolkata, Deepayan, 2000, p. 134.

[88]:

guḍū cīpippalīmūlanāgaraiḥ pācanaṃ smṛtam || (Śāraṅg. S. –II/2/9); Śāraṅgadhara-Saṃhitā: A Treatise on Ayurveda by Śāraṅgadhara, trans. K. R. Srikantha Murthy, Varanasi, Chaukhambha Orientalia, 2017, p. 57.

[89]:

Rajneesh V. Giri & Smitha Rajneesh, Synopsis on Caraka Saṃhitā, Varanasi, Chaukhambha Orientalia, 2019, pp. 124-125.

[90]:

kirātatiktakaṃ tiktā mustaṃ parpaṭako'mṛtā |
ghnanti pītāni cābhyāsāt punarāvartakaṃ jvaram || (CS. Cikitsāsthāna–III. 236); Baidyacharya Kalikinkar Sensarma& Ayurbedacharya Satyasekhar Bhattacharya (eds.), Caraka-Samhita–Vol. II, trans. Kabiraj Jasodanandan, Kolkata, Deepayan Publication, 2013, p. 257.

[91]:

CS. –III.333-346; R. K. Sharma & Bhagwan Dash (eds.), Caraka Saṃhitā–Vol. III, Varanasi, Chowkhamba Sanskrit Series Office, 2017, p. 218-220.