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DETAILS

This type of fever is recurrent in nature with certain time gap in between. Visham Jwar is of 5 types.

1. Santataka Jwara – Affects Rasavaha Srotas. either gets cured or kills the patient on 12th, 10th or 7th day.

2. Satata Jwara – Affects Rakta Dhatu, In a day and night, Satataka Jwara occurs twice

3. Anyedyushka Jwara – Affects Rakta dhatu and Medovaha Srotas. Jwara occurs once per day.

4. Truteeyaka – Occurs on every third day (on alternate days). Asthi Dhatu and Mamsavaha srotas are involved.

5. Chaturtaka – occurs with a gap of two days. Afflicts Majja Dhatu and Medovaha Srotas. 

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TRETMENT

1.SANTATA-

The imbalanced spread all across the body through Rasavaha Srotas causing stiffness. Such a fever is called Santata Jwara. It manifests its symptoms very quickly and either gets cured or kills the patient on 12th, 10th or 7th day. It is extremely difficult to tolerate this type of fever.

If the Doshas involved in Santata type of Jwara is similar in property to the season (Kala), Dhatus (Dushya) and physical constitution (Prakruti), then it is Asadhya (incurable). If the Dhatus and waste products (urine, stool and flatus) are purified, then on 7th, 10th, or 12th days the fever gets subsided. However, if Dhatus and Malas are not purified then fever kills the patient on those days. The death of the patient occurs even if these Dhatus are partially purified.

The Santata Jwara is thus located on 12 factors namely, 7 Dhatus, 3 Doshas, Urine and stool. Even if the fever subsides on 12th day etc. the symptoms of Jwara may become latent. It may continue for a longer period and cure of this disease is extremely difficult. Therefore, the physician should first administered Apatarpana (fasting) treatment, followed by other treatments for fever.

Treatment-(1) Virechana (laxative) or Vasti to clean the bowels.

(2) Anti-pyrexia medicine like Sahadevi (Vernonia cineria), pecta daru (Adina cordifalia), Kiravellaka, Saptaparna, Dronapuspi (Lcweas cephalotcs), Tulasi (Ocimum sanctum), Kiréta Tikta (Swertia chirata) etc. should be singularly or in combination may be decocted and prescribed twice daily (30 to 40 ml)

(3) Godanti misrana, Saptaparna ghana vati are specific drugs.

(4) Ayush-64 is also a specific drug (developed by CCRAM)

(5) Ashva-Kanchuki Rasacleans the bowels and brings down temperature.

(6) J vara murari rasa is a good Herbomineral drug in this fever.

2.SATATA-

In Satataka Jwara Fever that occurs twice in a day, Dosha is mostly located in the Rakta Dhatu. It can be treated with success. It gets aggravated and subsided depending upon the nature of the time. In a day and night, Satataka Jwara occurs twice.

Treatment

(1) Same treatment as mentioned in Santata Jvara.

(2) Specific medicines are Guduchyédi Kvétha 30 to 40 ml twice a day.

(3) 'Samsamani vati' 250 mg tabs four times a day is a proven one.

(4) In chronic stage i.e. Kala-Azar,

Putapaka-vishama jvarantaka lauha' should be prescribed. It is Anti-malarial, good

haemetenic (raktavardhaka).

(5) Jayamangala rasa is also very efficacious in chronic stage. It is also effective in fevers

of unknown origin (Puo).

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3.Anyedyuska Jwara: Fever that occurs every day

Occurrence: Due to the support of the strength of any one from among the Kala (time), Prakruti (physical constitution) and Dushya (Dhatus). It occurs every day. It affects Medovaha Sira (fat channels) Here Rakta is vitiated.

Treatment

(a) Godanti misrana, Kirata ghana vati, Sudarshana ghan vati are given during fever to bring down the temperature and releive thirst, burning sensation etc.

(b) Vishama J varta‘tntaka Lauha, Mahé Sudarshana cht’irna, etc. drugs can be

used in suitable dosage.

4.Trtiyaka Jwara –

Fever that occurs on alternate days It occurs when Doshas afflict Asthi Dhatu (bone tissue). In this type of fever, Mamsavaha Srotas is also involved.

Treatment

The treatment is just like anyedyuska jvara. The specific drugs are Vishamusthyédi vati, pancha tikta ghana vati, Brhat Sarva Jvara Lauha/Vishama Jvarz‘mtaka Lauha.

5.Chaturthaka Jwara: Fever that repeatedly occurs after every 2 days. Here Doshas afflict Majja Dhatu (marrow) and Medovaha Srotas (Fat channels).

According to some scholars different types of Jwara viz, Anyedyuska, Trtiyaka and Chaturthaka are manifested because of the affliction of alternate Dhatu by the Dosha.

Treatment

The specific medicines are-

(1) Vishvatapa-harana rasa.

(2) Chiturthakari’ rasa and

(3) Putapakva vishama jvarantaka lauha.

Note In all types of Vishama Jvaras, the following asava and aristas should be prescribed

(a) Lauhasava

(b) Kuméryasava

(c) Amritarista.

Keeping in view the patient-specific needs.

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Why the fever spikes in Trutiyaka and Chaturtaka Jwara?

As a seed in the soil waits for the right time to germinate, similarly, imbalanced Dosha remain inactive in the Dhatus till suitable time. When the Dosha gains strength in time and when the power of the inhibiting factors (immunity) is subsided, then Trutiyaka and Chaturthaka types of Jwara occur.

Explanation for day gaps in Trutiyaka and Chaturthaka Jwara:

The Doshas, after manifesting their aggravated signs and symptoms, lose their strength and get located in their respective places. At the appropriate time, they again get aggravated to afflict the person with fever.

Trutiyaka type of Jwara is of three types as follows:

When manifested by the aggravation of

Trikagrahi – Kapha and Pitta, it afflicts the Trika (lumbo–sacral joint)

Prushtagrahi – Vata and Kapha, it afflicts the Prushta (back)

Shirograhi – Vata and Pitta, it afflicts the Shiras (head)

Similarly, Chaturthaka Jwara is of 2 types as follows, when manifested by the vitiation of

Kapha – afflicts calf– region in the beginning.

Vata – afflicts the head in the beginning.

Another variety of Vishama Jwara (irregular or intermittent fever) is called Chaturthaka Viparayaya.

Each of the 3 Doshas viz. Vata, Pitta and Kapha cause this disease by afflicting 2 Dhatus viz., Asthi (bone) and Majja (bone marrow).

Causative factor for Vishama Jwara:

The 5 types of Jwara are caused by Sannipata (Simultaneous vitiation of all the 3 Doshas). However, the Dosha which is predominant among 3 is considered the causative factor.

Manifestation of Jwara in a particular time because of the following factors:

Rutu – season

Ahoratra Dosha – variation of Doshas in day and night

Manasa balaabalat – mind’s strength or weakness

Viparyaya Jvara-

Another variety of Visama jvara (irregular or intermittant fever) is called "Caturthaka viparyaya". Each of the three dosas i.e. Vita, Pitta and Kapha cause this fever by

afflicting two dhatus viz., asthi and majja. In this Caiturtaka viparyaya, fever remains for two'days at a stretch and then 'for one day there is remission. There after fever again appears for two days. Thus one episode (attack) of four days has 3 phasesi.e. No fever for the first day.

Fever for two days, followed by absence of fever for one day

Caturthaka viparyaya is a variety of Caturtaka jvara which latter is also a type of Visama jvara, hence this also should be treated as a kind of Visama jvara.

Treatment-The management of Viparyaya jvara is the same. stated under Visama jvara cikitsa.

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OTHER TYPES OF VISHAMA JVARA...

(i) Pralepaka Jvara-It is a visargi type of fever caused by tridoshii, temperature shoots up in the afternoon or in the evening and there is lot of cold perspiration, resmbling the fever noted in rajayakshma (Tuberculosis) disease.

(ii) Vitabalasaka Jvara-Many authors consider this as a type of Sannipata jvara, manifests low fever, bodyache and edema on the body. It is Kapha predominant and produces symptoms like cough, cold, salivation. This clinical picture is also found in rajayakshma.  

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CHIKITSA

SANSHODHAN

1. Vatik visham jvar-anuvasan,niruha basti

2. Pattik visham jvar- virechana karma

3. Kaphaja visham jvar- vaman karma(shatphala ghrita pana)

SANSAMANA

1. Vardhamana pippali rasayan- 10-10 days

2. Rason siddha tila taila pana

3. Triphala curna + guda sevana

4. Krishna jeerak + guda sevana

5. Kali tulsi kvatha sevana

6. Nimba chal kvatha sevana

7. Ushna dugdha + tila taila sevana

8. Lehsuna svarasa + ghrita morning sevana 

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CHIKITSA- 

MALARIA

Definition

Malaria is a protozoal disease transmitted to man by the bite of the female anopheles mosquitoes.

Etiology of Malaria

Malaria is caused by the protozoan genus plasmodium. Four species are known to cause disease in man.

P. falciparum: also called malignant malaria

P. vivax : tertian malaria

P. ovale : tertian malaria

P. malariae : quartan malaria

N.B. Almost all deaths are caused by falciparum malaria

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Clinical features

The incubation period varies between 10-14 days in P. vivax, P. ovale, & P.falciparum, and

18days to six weeks in P. malariae. 

Early symptoms are non- specific- malaise, fatigue, headache, muscle pain and

abdominal discomfort followed by fever, nausea and vomiting is common.

• Classically malaria manifests in regular paroxysms of high grade fever, chills and

rigor, occurring every 2 days in P. vivax and P.ovale, and every 3rd day in P.

malariae, but irregularly in P.falciparum. Malarial febrile paroxysms (which are due

to rupture of schizonts and release of pyrogens) typically have 3 stages

􀂾 The “cold stage” the patient feels intensely cold & has shivering. This lasts

for 30 minutes to 1hour.It is characterized by vasoconstriction of vessels &

the temperature rises rapidly.

􀂾 The” hot stage” The patient feels hot & uncomfortable, & become delirious.

This stage lasts for 2-6 hours.

􀂾 The “sweating stage” patient will have profuse sweating & become very

much exhausted

Physical Findings

Uncomplicated infection has few physical findings except fever, malaise, and mild anemia, a

palpable spleen and liver and mild jaundice e especially in children. 

PATHYA-

- Purana Sali, Mudga, Masoor, Parval, Karela, Sahijan, Choulai, Gaduchi, Jeevanti, Makoya, Manukka, Anar, Laghu Ahar, Yavagu, Peya, Vilepi, Yava, Lajamanda, Daliya

APATHYA-

- Guru, vidahi, vistambhi, dushita jala sevana, ankurita anna, tilkuta, sweet, chole, lassi, chana dal

- Vegadharana, vyayama, divasvapna, sanana, adhyasana

NISHEDHJA-

- Nava jvar me divasvapna, snana, abhyanga, maithuna, krodha, dhimi hava   

RASODHI/BHASMA/PISTI-(120-250MG WITH MADHU/USHNODAKA)

- Visham jvarantak loha-(chirayata,parpat,devdaru,manasheela,guduchi,abhrakh,kharpar,loha)

- Sarva jvarhar loha-(loha,kajjali,triphala,vidanga,mustak)

- Mahajvarankush rasa-(parad,gandhak,vatsanabha,dhattura beeja,trkatu)

- Vishveshver rasa-(parad,gandhak,kharpar)

VATI-(250-500MG WITH USHNA JALA)

- Jvarghani vati-

- Saptaparna ghan vati-(saptaparna)

- Karanjadi vati-(karanj beej,parpat,atish,guduchi,patol,kutki)

CURNA-(3-6GM WITH MADHU/USHNODAKA)

- Sudarshan curna-(triphala,trimada,atish,chirayata)

- Pippali curna with dasamula kvatha

KAVATH/ASAV/ARISHTA-(20-40ML WITH SAMABHAG WATER)

- Kalingadi kvatha-(indrayava,patol patra,kutki)

- Nimbadi kvatha-(nimbachal,patolpatra,triphala,munakka,mustak,indrayava)

- Kiratiktadi kvatha-(chirayata,guduchi,raktchandan,sunthi)

- Jatyadi kvatha-(chameli patra,amalaki,mustak)

- Guduchyadi kwatha-(nimbchal,guduchi,dhaniya,padmakh)

- Patoladi kwatha-(parval,triphala,nimbchal,guduchi)

GHRITA-(20-40ML WITH USHNODAKA/DUGDHA)

- Shatpal ghrita-(panchkol,saindhav,ghrita)

- Panchkol ghrita-(panchkol,ghrita)

- Pippaliyadi ghrita

- Mahakalyanak ghrita-(shalparni, tagar, ela, hridradvya, sariva, ghrita)

- Patoladi ghrita