Charaka Jwara Nidana: 1st Chapter

The 1st Chapter of Charaka Samhita Nidana Sthana is called Jwara Nidana. It deals with causes, pathology,types and symptoms of Jwara – fever , as per Ayurveda. Chapter -1

Diagnosis of Fever (Jwara Nidana)

Synonyms of Nidana

Synonyms of Nidana – Causative factors and its Categories:
Synonyms of Nidana (Causative factor) in the present context
Hetu
Nimitta
Ayatana
Karta
Karana
Pratyaya and
Samutthana
Causative factors are of the following 3 categories:
Asatmyendriyartha samyogah — Unwholesome contacts of the sense organs with their objects
Prajnaparadah — intellectual blasphemy and
Parinama — seasonal vagaries [3]

Dual classification of disease

Diseases so cured are primarily of 3 types Viz.,
Agneya (Paittika)
Saumya (Slaismika) and
Vayvya (Vatika)
Some others, that is minor ones, are of 2 types viz,
Rajasa and
Tamasa. [4]

Synonyms of Roga

Words which are synonymous to Roga (disease):
Vyadhi
Amaya
Gada
Atanka
Yaksma
Jvara
Vikara [5]

Means of diseases

Diseases can be diagnosed by the study of
Nidana (etiology)
Purvarupa (premonitory symptoms)
Linga (actual symptoms)
Upashaya (exploratory therapy) and
Samprapti (Pathogenesis). [6]

Nidana, purvaroopa definition

Definition of Nidana – causative factor:
Nidana is already described to constitute the causative factors of diseases [7]

Definition of Purvarupa – Premonitory Symptoms:
Symptoms which manifest themselves before the appearance of the disease (premonitory symptoms) are known as Purva-Rupa [8]

Features of Lakshana

These words are synonymous in the present context. Symptoms when fully manifested are called
Linga (Rupa)
Akrti
Lakshana
Cchina
Samsthana
Vyanjana and
Rupa [9]

Definition of exploratory therapy

Such of the medicines, diets and regimens that bring about happiness either by acting directly against the cause of the diseases, and or the disease itself or by producing such effects indirectly are called Upashaya (exploratory therapy). [10]

Synonyms of Pathogenesis

These words are synonymous with the pathogenesis of a disease:
Samprapti
Jati
Agati [11]

Samprapti classification

Classification of Samprapti – pathogenesis:
Samprapti is further classified depending upon certain specific characteristics like
Sankhya – the number of the types of disease,
Pradhanya – dominance of the other attributes of Doshas and
Bala kala – the time of manifestation or aggravation of the disease [(1)]

Enumeration of disease

The number of the (types of the) disease is responsible for the variation of the Samprapti for example-
8 types of Jwara (fever),
5 types of Gulma (abdominal tumor),
7 types of Kushta (obstinate skin diseases including leprosy) [(2)]

Degree of Doshic- vitiation

If 2 out of the 3 Doshas get vitiated, the comparative term, that is ‘Tara’; is used to indicate the predominant one.
If, however, all the 3 Doshas get vitiated then the superlative term ‘Tama is used to indicate the most predominant one. [(3)]

Variety of diseases

Vidhi or variety of diseases can be illustrated as below:- diseases are 2 varieties according as they are
Nija – exogenous or
Aagantu – endogenous;
On the basis of vitiation of Doshas which are 3 varieties, viz,
Sadhya – curable
Asadhya – incurable
Mrudu – mild and
Daruna – acute. [(4)]

Definition of Vikalpa

Predominance of one or the other fraction of the 3 Doshas (in the manifestation of a disease) is known as Vikalpa in the present context. [5]

Time of manifestation of disease:
Specific time for the aggravation manifestation of diseases is determined on the basic of the variations in seasons, timings of the day, night and intake of food. [12]

Proper understanding of disease by the physician:
On the basis of these factors, the physician with the peace of mind and unimpaired intellect should understand the disease properly. [13]

Topics dealt with the section:
The above said are in brief about the topics to be dealt with in this section ‘Diagnosis of diseases’ (Nidana sthana). They will again be elaborately discussed hereafter. [14]

Diagnosis and line of treatment of eight diseases:
In the following paragraphs, we shall describe the diagnosis as well as the line of treatment of 8 diseases (of ancient times) which are manifested as a result of greed, enmity and anger in the order of the Nidana (causative factors etc.) Later, other disease (along with those of this section) will be described. [15]

Priority of fever:
Among the somatic disease, Jwara (fever) appeared in the beginning: hence it is being described first. [16]

Jwara Nidana

Jwara Nidana – Causative factors of fever:
The 8 factors responsible for the causation of fever in human beings are
Vata
Pitta
Kapha
Vata pitta
Vata-kapha
Pitta kapha
Vata pitta kapha and
Aagantuja – Extrinsic factors [17]

Specific factors of diseases:
We shall now explain the Nidana (etiology), Purvarupa (premonitory symptoms), Linga (actual symptoms) and Upashaya (exploratory therapy) – all these factors as specific to the various types of this disease (jwara or fever). [18]

Causes of aggravation of vata:
Vata gets aggravated by the
Ruksha aahara – over indulgence and the intake of ununctuous
Laghu shita aahara – light and cold things
Ati vamana – over administration of emesis
Ati virechana –  excessive purgation
Asthapana type of enema
Ati shiro virechana – excessive errhines
Vyayama – physical exercise
Vega sandharana – suppression of the natural urges
Anashana – fasting
Abhighata – assault
Vyavaya – sexual indulgence
Udvega – anxiety
Shoka – grief
Shonita atisheka – bloodletting in excess
Jagarana -vigil during the night and
Vishama sharira – by maintaining irregular posture. [19]

Samprapti

Pathogenesis of fever:
This aggravated Vata afflicts Amashaya (stomach including small intestine), gets mixed with Agni (enzymes responsible for digestion), 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 (enzymes responsible for tissue metabolism), extradites the heat from the site of digestion and spreads it all over the body, thus causing Jwara (fever). [20]

Vataja Jwara

Symptoms of Vataja Fever:
Following are the symptoms of this type of fever:-
Vishamarambha visargitvam – Irregularity in onset and alleviation
Ushmano vaishamyam – 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 reddish discoloration of nails, eyes, face, urine, stool and skin.
Excessive retention of urine and stool
Occurrence of different types of fixed or shifting pain in various organs of the body, for example, numbness in feet and piikayorudveana? – cramps in calf
feeling of looseness in knee joints as also in other joints
inactivity of thigh
Breaking, brushing, grinding, churning, cracking, bursting and twisting pain in waist, side, back, shoulder, arms, scapular region and chest
Stiffness of jaws
Noise in the ears
Pain in temples
Astringent taste in the mouth or dyspepsia
Dryness of mouth, palate and throat
Thirst
Impairment of the functions of heat
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 described to be its etiological factors and
Alleviation of the condition by the administration of such things as is of opposite qualities to its etiological factors. [21]

Pittaja Jwara

Aggravation of Pitta, pathogenesis and symptoms of Paittika fever:
Pitta gets aggravated by the excessive intake of
Ushna (hot),
Amla (sour),
Lavana (saline)
Ksara (alkaline) and
Katu (pungent) food,
intake of meals while suffering from indigestion and exposure to scorching sun, heat of fire, exhaustion, anger and irregular dieting.
This aggravated Pitta approaches the site of Agni in the Amashaya (stomach including small intestine), follows the path of Rasa which is the first product of food after transformation, obstructs the channel of circulation of Rasa and sweet, impairs Agni due to its liquidity, extradites Agni from the site of digestion, inflicts pressure and spreads all over the body, thus causing Jvara (fever).
Following are the symptoms of this type of fever (Pitta Jvara):
Simultaneous manifestation or aggravation of fever in 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
Mada – intoxication
Bhrama -giddiness and
Murccha – fainting
pittacchardanam – Bilious vomiting
diarrhea
aversion for food
Lassitude
Pralapa – delirium
Appearance of rashes urticaria in the body
Greenish or yellowish color of nails, eyes, face, urine, stool and skin
Hyper pyrexia
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 is of opposite qualities to its etiological factors. [22-24]

Kaphaja Jwara

Aggravation of Kapha and Pathogenesis of Kaphaja fever:
Kapha gets aggravated by the excessive intake of
Snigdha (unctuous)
Guru (heavy)
Madhura (sweet)
Picchila (slimy)
Shita (cold)
Amla (sour) and
Lavana (saline) food
Diva svapna (sleep during day time)
Harsha (merriment) and
Avyayama (lack of physical exercise)
This aggravated Kapha enters the Amashaya (stomach in clouding small intestine), gets mixed up with Agni (enzymes responsible for digestion), follows the course of Rasa which is the first product of food after transformation, obstructs the channels of circulation of Rasa and sweet, suppresses the activity of Agni (enzymes responsible for tissue metabolism) extradites heat from the site of digestion, inflicts pressure and spreads it all over the body thus causing Jvara (fever). [25-26]

Symptoms of Kaphaja fever:
Following are the symptoms of Kapha Jvara:
Simultaneous manifestation or aggravation of fever in the entire body specifically immediately after- food, during the fore-noon, in the evening and during the spring season.
Heaviness of the body
loss of appetite
salivation
sweet taste in the mouth
nausea
bradycardia
timidness and
vomiting
Reduced power of digestion
excessive sleep
stiffness
Tandra – drowsiness
cough, dysponea and
Pratishyaya – coryza
Shaitya – Feeling of cold
White color of nails, eyes, face, urine, stool and skin
Frequent appearance of 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 etiolocal factors and
Alleviation of the condition by the administration of such things as having qualities opposite to its etiological factors [27]

Etiological factors to aggravate all the Doshas:
Either 2 or all 3 Doshas in the body get aggravated all at a time- because of the combination of the etiological factors described earlier (paragraph nos 21, 24, 27) or due to the following :
Vishamashana – irregular dieting
Anashana -fasting sudden change in the food habit without following the proper procedure prescribed for it,
seasonal vagaries,
Gandhopa ghrana advisho apahatasya – inhalation of substance having unwholesome smell,intake of poisonous water, habitation near poisonous (artificial) material or mountain,
improper administration of oleation , fomentation, Emesis, Purgation, Asthapana, and Anuvasana types of enema and errhines,
giving improper diet after the administration of Panchakarma therapy,
improper child delivery and resorting, to the aggravated Doshas manifest Jvaras due to the simultaneous vitiation of 2 Doshas or all 3 doshas. [28]

Simultaneous vitiation of doshas:
Symptoms of fever-due to simultaneous vitiation of the 3 doshas (as described in Para 21, 21& 27) combine in different modes to constitute the symptoms of fever due to the simultaneous vitiation of 2 Doshas, Viz,
Vatapitta
Vatakapha and or
Sannipata (3 Doshas) [29]

Causes of exogenous fever

The exogenenous one (Agantu) caused due to assault (by staff etc) emotions (like libido etc.) spell (by the incantations prescribed by the Atharvan etc) and imprecations (of preceptors and those who have attained spiritual perfection) are the 8 types of fever; this is preceded with pain. For some time it remains exclusively exogenous and afterwards becomes associated with Doshas.
The exogenous fever caused by assault is associated with Vata having its abode in the vitiated Vata and Pitta.
The exogenous type of fever caused by spell and imprecation is associated with the vitiated Vata, Pitta and Kapha- all the 3 Doshas. [30]

Characteristic of exogenous fever and line of treatment:
The exogeneous type of fever is different from the other 7 types because of its specific symptoms, line of treatment and etiology.
This is treated with spiritual therapy like oblation, auspicious acts and Yajna, and other forms of rational therapy like fasting, intake of light diet, gruel and decoction. Thus the characteristic features of 8 types of fever are described. [30]

Types of Fever

Jvara (fever) is as a matter of fact of 1 type only characterized by Hyperpyrexia.
They are of 2 types depending upon the craving of the patient for hot or cold things.
Similarly as exogenous and endogenous it is of 2 types. In endogenous type of fever only 1 Dosha or a combination of Doshas may take part in the pathogenesis and such it is of 2 types. This is also of 2 types depending upon the craving of the patient for hot or cold things. This is of 3 Doshas viz.
Vata, Pitta, Kapha taking part in the pathogenesis of the disease.
This is of 4 types viz,
Vatika
Paittika
Slaishmika and
Sannipatika (combination of all 3 Dosha)
This is also of 7 types, Viz
Vatika
Paittika
Slasimika
Vata paittika
Pitta slaismika
Vata slaismika and
Sannipatika.
All these classifications are based on the permutation and combination of various Doshas. [32]

Jwara Poorva Roopa

Premonitory symptoms of fever:
The premonitory symptoms of Jvara (fever) are
Mukha vairasyam – dyspepsia
Guru gatratvam – heaviness in body
loss of appetite
congestion in the eyes
Lacrimation
excessive sleep
Arati – disliking for work
yawning
flexion
-tremors
Shrama – exhaustion
Bhrama – giddiness
Pralapa – delirium
Jagarana – sleeplessness
Roma harsha – horripilation
setting on edge of teeth
wavering liking and disliking of sound , cold, wind and sun;
Arochaka – anorexia
Vipaka – indigestion
Daurbalya – weakness
Anga marda – malaise
Sadanam – lassitude
Alpa pranata – low-vitality
dilatory tendency
laziness
loss of regular functions
aversion to work
disregard for instructions of preceptors (superiors)
disliking for the use of garland, ointment and food
aversion to sweet food, liking four sour, saline and pungent food.
All these premonitory symptoms appear before the onset of hyperpyrexia. Some of these symptoms also continue to exist during the period of hyperpyrexia. [33]

Description, mythological origin

Brief description of fever:
Thus the etiology, premonitory symptoms, symptoms, pathogenesis etc. of Vatika, Paittika and Slaismika type of Jvara have been described in detail: those of Dvandvaja (due to the simultaneous vitiation of 2 dosha) and Sannipatika (due to the simultaneous vitiation of 3 Doshas) are also described in brief. [34]

Mythological origin of fever and its effects:
Jvara (fever) is an outcome of the wrath of Mahesvara. It leads to the death of all living beings. It afflicts with misery the body (by producing heat), senses and mind.
It diminishes the
Prajna – intelligence
Bala -strength
Varna – complexion
Harsha – joyfulness and
Utsaha – enthusiasm
It produces
Shrama – exhaustion
Klama – exertion
Moha – unconsciousness and
Aparodha – obstruction to food.
It is known as jvara because it brings miseries to the body (jvarayati= to bring misery). No other disease is so serious, so complicated and as difficult of cure as Jvara (fever) is.
This is the king of all diseases and different animals it is known differently. All living beings are unable to remember anything of their past life. At the end, it is Jvara which takes away the life. [35]

Line of treatment

Jwara Chikitsa Sutra – Line of treatment:
During the stage of Purvarupa (premonitory symptoms) or in the primary stage of Jvara (fever), intake of Laghvashana (light food) or Apartarpanam (fasting) is useful because Amashaya (stomach including small intestine) is the site of the origin of this disease.
Thereafter, depending upon the Dosha involved and the therapeutic property, the patient is administered
Kashaya – decoction
Pana – drink
Abhyanga – unction
Sneha – oleation (therapy)
Sveda – fomentation
Pradeha – ointment
Parisheka – bath
Anulepana – application of pasted medicine
Vamana – emesis
Virechana – purgation
Asthapana type of enema
Shamana – alleviation therapy
Nasya karma – inhalation
Dhupana -smoking
Anjana – collyrium and
Kshira bhojana – milk preparations [36]

Use of ghee in fever:
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 alleviating the particular Dosha(s) involved. Vata 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 taste, 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 (because it acts both against disease as well as the Doshas involved).
Thus it is said: – as people spray water over a house set on fire, so also ghee is used a view to alleviate chronic jvara.
Vata is alleviated due to latter’s ununctuousness, Pitta due to coldness and even Kapha which has identical properties (with ghee) due to suitable method of preparation. No other fact so carries the properties of drugs with which it is processed as ghee, hence ghee is considered to the fat par excellence. [37- 40]

Clarification regarding repetition:
It is only for the clarity that something already stated in prose is again repeated in verse. This kind of repetition does not constitute any defect. [41]

Brief description:
There varieties of etiological factors and their synonyms, the 5 fold classification of disease and its synonyms, 5 factors for the diagnosis of diseases, 8 types of fever, its distant and immediate causes, its premonitory symptoms, actual symptoms, and treatment in brief- all these were explained to Lord Agnivesha by the enlightened one-Lord Punarvasu. [42- 44]
Thus ends of the first chapter on the “Diagnosis of fever” of the Nidana section of Agnivesha’s work as redacted by Charaka.