Internal Medicine (d): Fever

Accounts of feverish illness are found in some versions of the Chapter on Medicine. There are different remedies mentioned for this condition.

The following records are pertaining to such illness.

Theravāda:—“At that time the Venerable Sāriputta had a feverish illness. Then the Venerable Mahāmoggallāna approached the Venerable Sāriputta. Having approached [him], [the Venerable Mahāmoggallāna] said this to the Venerable Sāriputta: ‘In the past, friend Sāriputta, by what does your feverish illness become comfortable?’ ‘For me, friend, by lotus sprouts and lotus stalks.’”^[1]

Dharmaguptaka:—“At that time there was a monk afflicted with fever in the body. The physician instructed [him] to use sandalwood for the purpose of relieving the illness. The monk informed the Buddha [about this]. The Buddha said: ‘[I] allow the use.’ [Things] like agarwood, sandalwood, gum guggul, kālānusārya^[2] –the Buddha said: ‘[I] allow using [these] to anoint the body.’”^[3]

Mahīśāsaka:—“There was a monk who got a feverish illness [and] he should consume ghee. The monks begged [this] for him; they could not get it, but obtained milk. [They] informed the Buddha about this [matter]. The Buddha said: ‘[You] should cause a lay attendant to make ghee [by] boiling [the milk until] it is done, [and] to make [it] without the smell of food. It is [to be] accepted for use in seven days.’”^[4]

“There was a monk who got a feverish illness and he should consume rock sugar. The monks begged [this] for him; they could not get it, but obtained sugar cane. [They] informed the Buddha about this [matter]. The Buddha said: ‘[You] should cause a lay attendant to make rock sugar [from sugar cane], [and] to make [it] without the smell of food. It is [to be] accepted for use in seven days.’ The monks did not know how long it took for it to be done. [They] informed the Buddha about this [matter]. The Buddha said: ‘By using a ladle to raise and pour it: [when] it becomes continuous, it is done.’”^[5]

“There was a monk who got an epidemic feverish illness. The Buddha said: ‘[You] should consume a medicine causing vomiting and purgation, take rest, control the amount of diet, [and take] food which is suitable to the illness.’”^[6]

Sarvāstivāda:—“The Buddha was still in Śrāvastī. At that time the elder Śāriputra had a disease of hot blood.^[7] The physician said: ‘[You] should use beer.’^[8] Śāriputra said: ‘The Buddha has not allowed me to use beer.’ The monks informed the Buddha about this matter. The Buddha said: ‘[I] allow the consumption of beer.’ The elder Upāli asked the Buddha: ‘What things are used to make beer?’ The Buddha said: ‘[Things] such as sprouted rice-grains^[9] –whether grinded or pounded–they are mixed with oil. [They are then] mixed with equal amount of water, [and] are caused to become sour. [The beer] should be used during proper time, and should not be used in improper time.’”^[10]

“The elder Śāriputra had a disease of hot blood. The physician said: ‘Should eat things from the pond.’ … The Buddha said: ‘… What are the things from the pond? [Things] such as lotus root, lotus seed, water chestnut, [and] seed of fox nut plant. Such various things from the pond are allowed for eating.’”^[11]

“The Buddha was in Śrāvastī. The elder Śāriputra was afflicted with a disease of hot blood. Then the physician instructed: ‘Wash [yourself] with suomoni-water 娑摩尼水 (śamanī?).’^[12] Upāli asked the Buddha: ‘What things are used to make suomoni-water?’ The Buddha said: ‘Except the poisonous trees, [you] take the flowers [and] leaves of all other trees to make [it].’”^[13]

“The Buddha was in Śrāvastī. At that time the elder Śāriputra [was afflicted with] a disease of hot blood. The physician instructed: ‘Drink the milk [which] has a burning[-hot] stone put in it.’ [Śāriputra] replied: ‘The Buddha has not allowed drinking the milk [which] has a burning[hot] stone put in it.’ [He] informed the Buddha about this matter. The Buddha said: ‘[I] allow drinking the milk [which] has a burning[-hot] stone put in it.’”^[14]

Mahāsāṃghika:—“The Buddha said: ‘... Scented substance is: sandalwood, agarwood, [and], as these examples, all scented substances should not be applied. If [one has] a feverish illness [and] the physician says: “[You] should need sandalwood for anointing.” Then [one] can use scented substance for anointing. When [one] wants to anoint [with scented substance], [he] should first offer it to a Buddha stupa; then [he] anoints [his] body [with scented substance]. Having anointed [his] body [with scented substance], [he] cannot stay amidst the community; [he] should stay in a concealed place. [When] the illness is relieved, [he] should clean [himself] by bathing; [after] bathing, then [he can] go to the community.’”^[15]

Treatments which are mentioned in the above cases are summarised into several categories:

1. use of parts of lotus plant (such as lotus seed, lotus sprouts and stalks) or objects obtained from a pond (such as water chestnut and seed of fox nut plant);
2. consumption of certain foods or drinks (such as ghee, rock sugar, beer, and hot milk);
3. anointing or washing the body with scented substances or certain fluids (such as agarwood, sandalwood, gum guggul, kālānusārya, and suomoniwater);
4. medicines causing emesis and purgation, together with rest and appropriate nourishment.

In Āyurveda, fever (dāha or jvara) is an important illness and it is regarded as “the foremost among the diseases” (Caraka Saṃhitā Cikitsāsthāna 3. 4). The classical medical treatises have lengthy chapters discussing it. Fever is classified as eight types in these texts: seven due to various combinations of humours aggravated by their respective causative factors (i.e. three types by each humour, three by dual combinations, and one by the combination of all three humours), and one due to external causes (such as injury, poison, inhalation of a poisonous plant, possession by an evil spirit, curse by a divine being, sorcery, anger, fear, grief, and so on) (Caraka Saṃhitā Nidānasthāna 1. 17, 19, 22, 25, 30; Suśruta Saṃhitā Uttarasthāna 39. 14-15, 19-22; Aṣṭāṅga Hṛdaya Saṃhitā Nidānasthāna 2. 3, 38-45). Aggravated humour(s) reach the site of digestion (the stomach and small intestine) and expel the digestive fire from its seat. The heat of the humour(s) and the dislodged digestive fire then obstruct the channels for nutrient fluid and sweat, causing the heat to further aggravate and pervade the whole body. This gives rise to fever (Caraka Saṃhitā Cikitsāsthāna 3. 129-132; Suśruta Saṃhitā Uttarasthāna 39. 15-19; Aṣṭāṅga Hṛdaya Saṃhitā Nidānasthāna 2. 36). External factors cause fever via their associations with the humours (Caraka Saṃhitā Nidānasthāna 1. 30; Suśruta Saṃhitā Uttarasthāna 39. 19; Aṣṭāṅga Hṛdaya Saṃhitā Nidānasthāna 2. 43-45).

Various therapeutic measures are utilised in Āyurveda to treat fever, for the purpose of alleviating aggravated humours, restoring digestive fire, and relieving fever and other associated symptoms. These therapies include fasting; light diet (such as thin gruel); drinks prepared with bitter drugs; drugs for emesis, purgation, and enema; ghee and milk (which may be cooked with drugs); medicinal decoctions; bathing or sprinkling the body with medicated oil; massage; perspiration treatment; inhalation of smoke; application of collyrium; use of gargle; and so on.^[16]

In modern medicine, fever (pyrexia) is defined as “an elevation of body temperature that exceeds the normal daily variation and occurs in conjunction with an increase in the hypothalamic set point [e.g., from 37°C to 39°C (98. 6°F to 102. 2°F)]” (Dinarello and Porat 2012, 143). Many diseases can present with fever. The most common ones are infections; others include autoimmune diseases, central nervous system diseases, malignant diseases, cardiovascular diseases, gastrointestinal diseases, and so on (Gonzales ad Nadler 2012, 37, table 2. 7). Modern medicine has also distinguished two other groups of feverish illness: fever of unknown origin and hyperthermia. The former is “reserved for unexplained cases of fever exceeding 38. 3°C on several occasions for at least 3 weeks in patients without neutropenia or immunosuppression,” and the latter “occurs when body metabolic heat production or environmental heat load exceeds normal heat loss capacity or when there is impaired heat loss; heat stroke is an example” (Gonzales ad Nadler 2012, 36). Management for feverish illnesses include removal or treatment of underlying causes; and measures to lower body temperature back to normal range, such as cold sponges, ice bags, fans, ice baths, and so on. Antipyretic drugs such as paracetamol (acetaminophen) can be used. Antimicrobial agents are administered if infections are diagnosed (Gonzales and Nadler 2012, 36-37).

Records of feverish illness are found in the Chapters on Medicine. Such illness was treated by various means including consumption of lotus plant parts or objects from ponds; intake of certain diets such as ghee, milk, and even beer; application of scented substances or humour-allaying water; and use of emetic and purgative drugs together with rest and suitable post-treatment nourishment. Āyurveda has more elaborative teachings on this medical condition and the treatments. Modern medicine considers fever as a symptom or sign rather than a disease. It can occur in many diseases or medical conditions. Treatments involve curing the underlying cause and symptomatic relief by means of cooling measures and/or drugs.

Footnotes and references:

[1]:

Theravāda Vinaya Piṭaka I. 214: “tena kho pana samayena āyasmato Sāriputtassa kāyaḍāhābādho hoti. atha kho āyasmā Mahāmoggallāno yenāyasmā Sāriputto ten’ upasaṅkami, upasaṅkamitvā āyasmantaṃ Sāriputtaṃ etad avoca: pubbe te, āvuso Sāriputta kāyaḍāhābādho kena phāsu hotīti. bhisehi ca me āvuso muḷālikāhi cā’ti.”

[2]:

The exact substance for kālānusārya is not certain, as discussed in footnote 130 of Chapter Four.

[3]:

Taishō Tripiṭaka 1428. 870c10-13: “爾時有比丘患身熱，醫教用栴檀，為差病故。比丘白佛，佛言：「聽用。」若沈水、若栴檀、畢陵祇伽羅[少/兔]婆羅，佛言：「聽用塗身。」”

[4]:

Taishō Tripiṭaka 1421. 147b14-17: “有一比丘得熱病應服酥，諸比丘為乞不得，而得乳。以是白佛，佛言：「應使淨人作酥，煎令熟，作無食氣，受七日服。」”

[5]:

Taishō Tripiṭaka 1421. 147b20-24: “有一比丘得熱病應服石蜜，諸比丘為乞不得，而得甘蔗。以是白佛，佛

言：「應使淨人作石蜜，作無食氣，受七日服。」諸比丘不知幾時應熟。以是白佛，佛言：

「以杓舉瀉，相續不斷為熟。」”

[6]:

Taishō Tripiṭaka 1421. 147c13-15: “有比丘得時行熱病，佛言：「應服吐下藥，消息，節量食，隨病食。」”

[7]:

The Sarvāstivāda Vinaya uses a unique term “熱血病” which literally means “hot blood disease”. Although it is different from other Chinese terms for feverish illness which obviously talk about feverish illness, this term should refer to such sickness because of similarities of the concerned cases and the employed treatments when compared with the parallels in other Vinayas.

[8]:

首盧漿 should be surā, which is an alcohol drink and a kind of beer. See A Sanskrit-English Dictionary, s.v. “surā”. Srikantha Murthy has translated the term as beer in his translation of the Aṣṭāṅga Hṛdaya Saṃhitā (translator’ notes to Sūtrasthāna 5. 67).

[9]:

蘗 refers to the sprout of a seed or grain (Shu et al. 2005, 1179). Thus 蘗米 means the sprouted rice-grains.

[10]:

Taishō Tripiṭaka 1435. 185b29-c5: “佛故在舍衛國。時長老舍利弗熱血病，藥師言：「應服首盧漿。」舍利弗言：「佛未聽我服首盧漿。」諸比丘以是事白佛，佛言：「聽服首盧漿。」長老優波離問佛：「何等物作首盧漿？」佛言：「若糵、若磨、若擣合油，等分以水和之令酢，時應服、非時不應服。」”

[11]:

Taishō Tripiṭaka 1435. 190c24-191a8: “長老舍利弗熱血病，藥師語言：「應食池物。」...佛言：「...何等池物？若蓮根、蓮子、菱、芡雞頭子，如是種種池物聽食。」”

[12]:

Suomoni-water 娑摩尼水 probably refers to śamama or śamanī, which means “calming, tranquillizing, soothing, allaying, extinguishing, destroying;settler, destroyer” and so on in Sanskrit (A Sanskrit-English Dictionary, s.v. “śamana” and “śamanī”) and alleviator of doṣas in Āyurveda (Caraka Saṃhitā Cikitsāsthāna 3. 160161).

[13]:

Taishō Tripiṭaka 1435. 275c25-28: “佛在舍衛國。長老舍利弗患熱血病，時藥師教言：「以娑摩尼水洗。」優波離問佛：「用何物作娑摩尼？」佛言：「除毒樹，取餘一切樹華葉作。」” This account is not within the Sarvāstivāda Bhaiṣajyadharmaka.

[14]:

Taishō Tripiṭaka 1435. 277a13-15: “佛在舍衛國。爾時長老舍利弗熱血病，藥師教言：「燒石著乳中飲。」答言：「佛未聽燒石著乳中飲。」是事白佛，佛言：「聽燒石著乳中飲。」” This account is not within the Sarvāstivāda Bhaiṣajyadharmaka.

[15]:

Taishō Tripiṭaka 1425. 494b3-8: “佛言：「...香者，栴檀、沈水，如是比一切香皆不應著。若熱病，醫言：

『當須旃檀香塗。』爾時得用香塗。若欲塗時，先應供養佛泥塔，然後塗身。塗身已不得

在眾中，當在屏處。病差淨澡，浴身然後入眾。」” This account is not within the Chapter on Medicine parallel of the Mahāsāṃghika Vinaya.

[16]:

These measures are extracted from the relevant chapter of the classical Āyurvedic treatises. Detailed descriptions of treatments can be found in Caraka Saṃhitā Cikitsāsthāna 3, Suśruta Saṃhitā Uttarasthāna 39, and Aṣṭāṅga Hṛdaya Saṃhitā Cikitsāsthāna 1. Numerous drugs are used in Āyurveda for curing fever, including a lot of scented substances, as well as lotus flowers or their parts.