By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Sutika Jwara means fever occurring in woman during puerperium. Fever manifesting in puerperal woman should be given special attention and treated while following the other regimen of puerperal period.
Sutika – puerperium / puerperal woman
Jwara – fever
Master Kashyapa opines that the fever is the most troublesome amongst all the other disorders. This is true in case of puerperal woman and also in other persons.
Read – Postpartum Afterpains – Causes, Symptoms, Treatment
6 kinds of fevers manifest in puerperal women. These are classified into 2 groups of fevers –
A. Nija Jwara – endogenous fevers caused by doshas
B. Agantuja Jwara – exogenous fevers
A. General causes
Master Charaka and Sushruta opine that a woman suffers from fever caused by 2 or 3 doshas or due to trauma (external factors) are caused due to –
Causes for puerperal fever mentioned by Master Kashyapa –
Causes of Sannipataja Jwara – fever caused by vitiation of all three doshas in puerperal women (Ka.Sam.Khi.11 / Ka.Sam.Kalpa.8)
Puerperal woman –
The pathogenesis of Puerperal Fever is explained in Kashyapa Samhita, Khilasthana, 11th chapter.
Due to the over exertion caused by continuous and strong labor pains the body of the puerperal woman becomes languid. As a consequence, vata and other doshas get aggravated, the sense organs get exhausted and the tissues lose their essence due to hemorrhage. Even if a single dosha gets aggravated in this context, it gives enormous trouble to the woman.
Master Kashyapa explains this condition with the suitable similies.
The doshas in a state of balance sustain the body functions. In case of decline of their balance, the puerperal woman suffers from fever characterized with rise in temperature. The temperature quickly rises just like the dry wood catches fire.
The intensity of fever increases severely due to the below mentioned factors –
1. Vataja Fever Symptoms
2. Pittaja Fever Symptoms
3. Shleshmaja / Kaphaja Fever Symptoms
4. Sannipataja Fever Symptoms
5. Stanyotpatti Janya Fever Symptoms
On the 4th or 5th day after delivery, milk starts appearing in the breasts. This milk reaches the breasts – stanya vaha srotas and influences them to produce the below mentioned symptoms –
This fever subsides as soon as the milk is properly drained from the breasts.
Read – Breast Milk Disorders: Symptoms, Detoxification, Remedies
6. Grahottha Fever Symptoms
Below mentioned are the symptoms of fever arising due to sight of grahas, fear, vata, trauma and shaking or trembling –
This condition shall be treated by administering the treatments to pacify grahas and other treatments prescribed to treat vataja fevers.
Read – Ayurvedic Post Natal Mother Care Based On Season And Place
Principles of treating puerperal fever
Dosha Upashamana – The wise physician should try to pacify the doshas which have got aggravated by even the slightest of etiological factors considering the quantity of aggravation.
Dhatu Prasadana – The tissues should be gratified, purified and strengthened.
Other key measures to treat puerperal fever –
Other principles in the treatment of puerperal fever –
When the below mentioned conditions are associated with puerperal fever, the physician should advice fasting –
After the woman has fasted, manda – thin gruel, scum of boiled rice etc should be served.
Read – Intrauterine Death Of Fetus In Ayurveda
Shamana – pacifying / palliative measures
Puerperal woman should be administered with pacifying or suppressive measures in below mentioned conditions –
She should be prescribed with peyadi krama – sequence of dietetic regimen wherein the food is gradually graduated from liquid to semisolid to solid food over a period of time. If the woman is fasting she should be given with scum of boiled rice etc in that order.
Peya – tisane – increases digestive fire, pacifies the tissues, and removes the abnormalities caused by fetus or delivery. Manda – scum of boiled rice digests ama associated with doshas. Further, medicated or non-medicated soups or meat-soups should be prescribed.
In kapha-pittaja type of fever, pacifying herbs should be used from the 5th day itself.
Read – Ayurveda Lifestyle and Diet For Fever – 45 Important Things To Know
Kashaya – use of herbal decoctions
Once the doshas (ama associated with) gets digested and fever gets reduced due to consumption of graduated dietetic protocol i.e. samsarjana krama, pachana kashaya – digestive decoction should be prescribed after 5 days and anulomana kashaya – i.e. excretory decoction should be used.
Carminative / excretory decoction should be used in a woman in whom the fever caused due to vata is pacified with use of herbal oil massage and meat soup and when the doshas located in the large bowel are suppressed. For dietetic purpose – light cereals mixed with liquid meat soup of wild animals should be prescribed.
Read – Use Of Water In Fever, Rules, Method, Ayurveda Perspective
Treatment of vata-pittaja fever – Use of ghee
When the fever doesn’t pacify with the above said treatment principles, medicines, therapies or diet, it should be considered as vata-pittaja fever. This type of fever gets pacified only with use of ghee just like the forest fire subsides with rain. Use of ghee is therefore the main treatment once the digestive fire gets purified and disease subsides. Many diseases occurring in woman who has undergone abnormal labor get cured with use of ghee.
Principles of treating sannipata fever – fever caused by all three doshas
In fevers caused due to all three doshas, wherein vata is strong, medicated meat soup or cereals and old ghee should be used.
Shodhana – purifying therapies in puerperal fever
After delivery, the blood gets excreted through uterus. The doshas following the blood also trickle down. In such conditions the doshas in the body are comparatively less in amount. Therefore the cleansing measures of the forms of emetics, sternutatory herbs / errhines, purgatives or enemas should not be given.
The same principle holds good in treatment of puerperal fevers. Woman suffering from puerperal fevers who has lost sufficient amount of doshas from the body should not be administered with strong emetics and purgatives with pungent herbs. Due to the heat generated in the body due to fevers, the tissues undergo suppuration (due to metabolic changes). Use of pungent herbs as emetics or purgatives makes these tissues abnormal.
Read – Vamana – Emesis In Fever
Indication of emetics – Mild emetics should be prescribed in fever caused by kapha –
Indication of errhines – Errhines should be prescribed in puerperal fever when
Treatment of fever caused by vitiated vata in puerperal woman
1. Sudation – Sankara type of sudation should be administered. It is prepared with –
All these ingredients should be mixed with powder of cow dung and ground with kanji – fermented liquid is beneficial for giving sudation. It should be a given at the onset of the vataja fever.
2. External applications for convulsions associated with fever –
a. Massage should be given with hot oil. Fumigation should be done with Suradaru – Cedrus deodara. Later lukewarm paste of Sarvagandha herbs i.e. herbs having fragrance prepared with kanji – fermented liquid should be done.
b. Tub bath – should be given with hot kanji – fermented liquid mixed with decoction of the below mentioned herbs –
Fumigation – Fumigation with Guggulu – Commiphora mukul mixed with ghee should be given after tub bath. The woman should then be wrapped with a blanket and seated over a skin-covered seat. Later, she should be given with hot foods and drinks.
3. Use of oils – Dwipanchamuladi oil should be used internally or externally or both forms to cure vata type of fever. (Ka.Sam.Khi.11)
4. Internal medication –
a. Decoction of Brhat Panchamula or Vidarigandha – Desmodium gangeticum should be given mixed with rock salt
b. Rasnadi Kashayam – Decoction prepared with the below mentioned herbs should be given for oral consumption –
Following this, decoction water medicated with root of Bilva – Aegle marmelos should be used.
c. Yavadi Ghrta – Ghee prepared with the decoction of below mentioned herbs should be given for oral consumption –
Following the use of this ghee, purgation should be given with ghee medicated and prepared using Shyama – black variety of Operculina turpethum and Tilwaka – Symplocos racemosa.
5. Diet – Food should be taken at proper time. It should include soup prepared with Panchamustika, sour gruels, salt and meat soup of wild animals and birds or that of animals and birds living in desert like / dry regions.
1. Principles – Use of hot air is contraindicated since heat or hot things are antagonistic to pitta.
Fever caused due to vitiated pitta when not associated with complications should be treated with
Foods and drinks rich in sour, hot and pungent and bitter things should not be used. The opposite things i.e. foods rich in sweet, bitter and astringent tastes and cold in nature should be used.
2. External application
a. Darvadi Pradeha – The below mentioned herbs should be pestled and the paste should be applied –
b. Madhukadi Taila Abhyanga – Massage should be given using oil prepared with paste of Madhuka – Glycyrrhiza glabra and Tagara – Valeriana wallichii.
Read – Abhyanga Ayurvedic Massage: How To Do? Benefits, Oil Choices
3. Internal medication
a. Sthiradi Kashayam – Decoction prepared with the below mentioned herbs shall be cooled and administered mixed with honey and sugar –
b. Sarvabhishava Raja – The below mentioned herbs are kept in water overnight.
Next morning, after straining the contents, it should be mixed with sugar and fine powder of Katuki – Picrorhiza kurroa. This should be given for drinking. This is known as king of beverages used in treatment of fevers.
c. Mrdvikadi Panakam – Sweetened cold percolation of the below mentioned herbs is given –
d. Bhadrashriyadi Kashayam – Decoction of the below mentioned ingredients should be used –
e. Mudga yusha – Soup of green gram mixed with Prsniparni – Uraria picta and Sthira – Desmodium gangeticum cures fever associated with diarrhea.
f. Laja Peya – Drink prepared with laja – parched paddy – added with the below mentioned herbs cures vomiting, unconsciousness, burning sensation and fever –
This drink should be taken with soup of green gram or decoction of Madhura group of herbs – group of sweet tasting herbs.
g. Madhukadi Leha – Confection prepared with the below mentioned herbs is beneficial –
h. Madhukadi Taila – Oil prepared using paste of Licorice and Tagara – Valeriana wallichii should be used.
i. Patoladi Ghrta – Ghee prepared with the below mentioned herbs cures fever of pitta origin –
j. Ghrta – Ghee prepared with Chandanadi group of herbs or Patoladi group of herbs or Tikta Ghrta or Tittiradya Ghrta are beneficial.
k. Sarngishtadi Asava should be given mixed with honey.
4. Virechana and Pradeha – Purgation and unction
After the remission of fever the woman should be given purgation with paste of Chaturangula – Cassia fistula, Raisins and Trivrit – Operculina turpethum. Unction should be given with paste of Devadaru – Cedrus deodara, leaves of Talisa – Abies webbiana, Ushira – Vetiveria zizanioides and Sandalwood.
Treatment of fever caused by vitiated kapha in puerperal woman
1. Principles of treatment
Fever of kapha origins should be treated with the below mentioned remedies after the remission of fever by use of diet given on lines of samsarjana krama i.e. graduated dietetic protocol –
Processed water – Hot water processed with dry ginger and Amaradaru – Cedrus deodara should be given to drink.
Diet – Soup prepared with young radish or meat of animals and birds living in dry / desert like land or meat of wild animals – mixed with bitter and hot herbs and little quantity of fat. Treatment prescribed for vata fever is also beneficial.
Contraindications – Foods and drinks rich in sweet taste, unctuous and heavy should not be used. The foods and drinks having opposite qualities shall be used.
2. External medications
a. Lakshadi Taila Abhyanga – Massage should be given with oil prepared from the below mentioned ingredients –
b. Kushtadi Taila Abhyanga – Oil prepared with the below mentioned ingredients should be used for massage –
3. Internal Medication
a. Brihatyadi Kashayam – Decoction prepared with the below mentioned herbs should be use –
b. Dwi Panchamuladi Kashayam – Decoction of the below mentioned herbs is useful when used mixed with rock salt –
c. Patoladi Kashayam – Decoction prepared with below mentioned herbs should be given mixed with honey –
d. Purgation – Paste of Trivrt – Operculina turpethum should be given with urine of cow for purgation.
e. Kalyanaka Ghrta and Dashamula Ghrta are beneficial when administered in suitable period in suitable doses.
Treatment of fever caused by all three vitiated doshas in puerperal woman
Fevers caused by vitiation of all three doshas when associated with manifestation of all the clinical features of the doshas will become incurable whereas that with few signs and symptoms is cured with difficulty.
This fever will never get cured in puerperal women who have lost their strength and digestive capacity. It is also incurable in those women who have lost their tissues, strength and ojas – essence of all tissues.
Read – Dhatu – 7 Body Tissues As Explained In Ayurveda
1. Treatment principles
The predominant dosha among the three doshas should be pacified at first. Later the other two doshas should be dealt with.
If all three doshas are equally vitiated, kapha should be treated at first. This is because the kapha it gets adhered to the other doshas, is heavy in nature, gets metabolized with difficulty and is situated in the upper part of the body. After pacifying kapha, the puerperal woman should be treated by considering the stage of fever, on the lines of treating fevers caused by vata, pitta, kapha etc.
Body massage should be given with oil medicated with hot or cold herbs and other measures capable of suppressing tridoshas also should be used.
2. External Medication
Sudation – the below mentioned herbs should be cooked in the form of oleo –
The cooked ingredients should be spread properly over a sheath of leather and sudation should be given to the woman lying on this oleo after covering her with heavy cloth.
b. Water processed with Haritaki – Terminalia chebula, Priyangu – Callicarpa macrophylla, Malati – Aganosma heynei / Caombretum indicum and Amalaki – Emblica officinalis should be given for mouth wash. Similarly water prepared with Vasa – Adhatoda vasica or Khadira – Acacia catechu should be used.
c. Powdered stone of mango fruit mixed with Rasanjana should be used to rub gums, lips and tongue.
d. Paste of Sarjarasa – Vateria indica, Barley and Ashwagandha – Withania somnifera should be mixed with curd and honey and applied on the forehead of the woman suffering from headache due to high fever.
3. Internal Medication
a. Nagaradi Kashayam – Decoction of the below mentioned ingredients should be given –
The decoction should be given with rock salt if the fever is rising both in the morning and evening. It should be given with honey and asafetida if the fever is rising only in the evening time.
Read – Ayurveda Home Remedy For Fever
b. Patoladi Kwatha – Decoction of the below mentioned ingredients should be mixed with ghee and given to a woman suffering from sannipata fever with vata predominance –
The same decoction mixed with honey is a good remedy for sannipata fevers with kapha predominance.
c. Eladi Kashayam – Decoction of the below mentioned should be served to a woman suffering from sannipata fever with pitta predominance, mixed with honey and sugar –
d. Bharangyadi Kashayam – Decoction of the below mentioned herbs should be administered mixed with rock salt and alkali of whole plant of barley so as to cause downward movement of doshas –
Alternatively Trivrit – Operculina turpethum mixed with cow urine or decoction of Vacha – Acorus calamus should be given. By these measures once the doshas have started moving in their proper channels and the intestine has regained digestive capacity and become strong, properly prepared ghee should be given for drinking purpose.
Read – Role Of Fasting In The Treatment Of Fever – Langhana In Jwara
e. Madhukadi Ghrta – Ghee prepared with the below mentioned herbs should be administered –
Alternatively Kalyanaka, Mahakalyanaka or Panchagavya Ghrta shall be used.
f. Meat soup and Dashamuladi Kashayam – Meat soup of animals living in desert like / dry lands mixed with old ghee should be administered –
Following this, decoction of the below mentioned ingredients should be given –
g. Pippali Duralabha Kwatha – Decoction of Piper longum and Fagonia cretica is useful.
h. Pippali Mrdvika Kashayam – Decoction of Piper longum and Vitis vinifera should be used.
i. Mangalyaka Ghrta – Ghee is prepared with juice of Guduchi – Tinospora cordifolia and amla along with paste of Sariva – Hemidesmus indicus, Ginger, Lodhra – Symplocos pariera, Pomegranate and Sandalwood is the best to relieve intermittent fevers and is also a useful remedy for all types of fevers.
Treatment of fever caused by breast milk and grahas in puerperal woman
The milk fever or fever caused by breast milk is cured by expressing out the milk. The fever caused due to grahas is cured by measures capable of eradicating grahas and by administering other treatments prescribed for fever due to vata.
In fevers caused by milk, diagnosing of dosha on the basis of specific clinical features, the pacification prescribed for that dosha should be used.
Formulations from Sahasra Yoga Text Book for Sutika Roga
Sutikantak Nasani Gudika
Sutikamaya Nasani Gudika
Bala Koduttuvadi Kashaya
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