Ayurveda Treatment Methods

A Guide Line To Ayurveda Treatments & Principles

 

JWARA (FEVER) Treatment Protocol by Ayush

 

 

INTRODUCTION

Jwara is a disease of Rasavaha Srotasa hav­ing its origin from Amashaya, resulting due to Agnimandya and presented with Santapa (raised body temperature), Swedaavrodha anhidrosis and Angamarda body ache as its cardinal features.All most all the infec­tious diseases (viral/bacterial) presenting with raised body temperature as predom­inant feature have been categorized under Jwara.

On the basis of predominance of Dosha and Dhatugata Avastha, Jwara has been classified into various types and while deciding the line of treatment, all these types are to be considered. For deciding the line of treatment, differential diagnosis among the Doshic varieties, Sama – Nirama Avastha, Nava- Jirna Avastha or Dhatugata Avastha or other presentations like Punaravartaka Jwara are considered.

Case Definition:

Patients presenting with raised body temper­ature associated with anhidrosis, associated with body ache, anorexia, headache, fatigue, weakness and lethargy.

Differential Diagnosis:

Differential diagnosis is essential for diag­nosing the type of Jwara and its stage. For the purpose of deciding line of management, the following stages should be diagnosed.

  • Sama / Nirama Avastha of Jwara
  • Taruna / Jirna Jwara
  • Eka / Dwi / Tridoshaja Jwara
  • Dhatugata Jwara
  • Sharira / Manasa
  • Agantuja / Nija Jwara
  • Punaravartaka Jwara

Jwara due to specific conditions like Romantika, Masurika, Pratishyaya, Kasa, Mutrakrucchra, Rajyakshma etc. should be diagnosed and treated accordingly.

LEVEL 1: AT SOLO AYURVEDA PHYSICIAN CLINIC

Clinical Diagnosis: Patient should be diagnosed on the basis of history of illness, degree of fever, onset, associated symptoms, chronicity, complications etc. The body temperature above the normal range of 36.5–37.5 °C (97.7–99.5 °F) or temperature in the rectum is at or over 37.5–38.3 °C (99.5–100.9 °F) or temperature in the mouth (oral) is at or over 37.7 °C (99.9 °F) or temperature under the arm (axillary) is at or over 37.2 °C (99.0 °F) shall also be taken into account.

Investigations:

  • CBC
  • Peripheral blood smear

 

Line of Treatment:

  • In Sama or Nava Avastha of Jwara, patients shall be kept on fasting or light diet.
  • After perspiration and some relief in body-ache, headache, light liquid diet or medicated water like Shadanga Paniya with few of the medicines mentioned below can be given considering the type of Jwara and its cause. In the Nirama or Jirna Jwara following medicines can be given as per requirement along with diet restrictions.

 

Table 6.1: Medicines at level 1 for Jwara

Drugs

Dosage form

Dose

Time of administration

Duration

Anupana

Nagaradi Kwatha1

Kwatha

10-30 ml

Before meal

1 week

-

Guduchyadi Kwatha2

Kwatha

10-30 ml

Before meal

1 week

-

Parpataka Kwatha3

Kwatha

10-30 ml

Before meal

1 week

-

Godanti Bhasma4

Churna

125-250 mg

Before meal / thrice a day

1 week

Warm water

Samshamani Vati5

Vati

2 Vati

(500 mg)

Before meal / thrice a day

1 week

Warm water

Mahasudarshana Churna6

Phanta

50 ml

Before meal / thrice a day

1 week

Warm water

Jwaramurari Rasa

Vati

125-250 mg

Before meal / thrice a day

1-2 weeks

Water / Madhu

 

Table 6.2: Management of Jwara as per the Doshik predominance at level 1

Vataja

Pittaja

Kaphaja

Vata - Pittaja

Pitta - Shleshmaja

Vata - Shleshmaja

Guduchyadi Kwatha

Patoladi Kwatha

Chaturbhadra Avaleha

Chandanadi Kwatha

Kantakaryadi Kwatha

Dashamula Kwatha

Drakshadi Kwatha

Duralabhadi Kwatha

Nimbadi Kwatha

Guduchyadhi Kwatha

Nagaradi Kwatha

Pippalyadi Kwatha

Rasnadi Kwatha

Vasadi Kwatha

Abhayadi Kwatha

Bharangadi Kwatha

Patoladi Kwatha

Panchakola Kwatha

Vishwadi Kwatha

Parpatakadi Kwatha

Vasa Kantakari Kwatha

Ushiradi Kwatha

Panchatiktaka Kwatha

Darvyadi Kwatha

 

 

Pathya - Apathya (Diet and life style):

Do’s -

  • Ahara: Shadanga Paniya (medicated water prepared by Musta, Parpataka, Ushira, Chandana, Nagara, Udichya), Tarpana prepared of the Laja Saktu (Churna of perched paddy) mixed with honey, sugar and juices of fruits, Mudga Yusha. Yavagu (gruel), odana (boiled rice) and Laja (popped or perched paddy), Peya prepared with Laja / Yava added with Nagar, Pippalimula, Amalaki, Mrudvika, vegetables like Patola, Karavellaka, Karkotaka.
  • Vihara: complete bed rest, staying in well ventilated room with hygienic conditions

Don’ts –

  • Ahara: Heavy food, curd, green peas, black eyed beans, lentils, yellow gram, black gram, raw vege­tables and salads, refined foods such as white flour (Maida), contaminat­ed water or food, sprouts, cold food and beverages, junk foods, fried food, bakery items.
  • Vihara: Physical and mental exer­tion like physical exercises, expo­sure to cold, breeze, suppression of natural urges, taking bath with cold water etc.

Referral Criteria: Patient not responding to above management, patient presenting with signs of high grade fever, delirium, severe vomiting, posing danger of dehydration or any such other complications like bleeding, anuria etc. shall be directly referred to Level 3 or higher centers for emergency management.

LEVEL 2: CHC’S OR SMALL HOSPITALS WITH BASIC FACILITIES

Clinical Diagnosis: The case referred from Level 1 or newly diagnosed case must be evaluated thoroughly. At this level, line of treatment to be planned considering Doshika involvement and cause of the Jwara.

 

Table 6.3: Clinical features as per Doshik predominance

Vata

Vepathu (shivering)

Vishama Vega (irregular intensity)

Kanth-oshtha

Shosha (dryness of throat & lip)

Nindranasha

(insomnia)

Shirahshoola (headache)

Pitta

Tikshna Vega (high intensity)

Atisara

(diarrhoea)

Nidraalpta (diminished sleep)

Vami

(Vommiting)

Mukhapaka (sore in mouth)

Kapha

Gaurav (heaviness)

Sheeta

(cold)

Utklesha (nausea)

Romaharsha (horripilation)

Atinidra (exessive sleep)

 

Vata-Pitta

Trishna (thirst)

Murchha

(fainting)

Bhrama (giddiness)

Daha (Burning

sensation)

Swapna-Nasha (insomnia)

Pitta-Kapha

Tiktaasayata

(bittermouth)

Tandra

(drowsiness)

Kasa (coughing)

Aruchi (anorexia)

Muhurdaha-muhurshitata (burning sensation alternate with chill)

Vata-Kapha

Staimitya (cold sweat)

Parvabheda

(jointpain)

Gaurava (heaviness)

Nidra (sleepiness)

Pratishyaya (sneezing)

Sannipatika

Nidranasha

(Insomnia)

Bhrama (giddiness)

Suptangata (numbness)

Aruchi (anorexia)

Stambha (Immobility)

Agantuja

Glani

(malaise)

Karshya

(emaciation

Gaurava (heaviness)

Chetana-prabhav (emotions persistent)

A

 

Table 6.4: Clinical features at the level of Dhatus.

Sl No

Dhatu

Clinical features

1

Rasa

Guruta, Dainya, Udvega, Sadana, Chhardi, Arochaka, Angamarda, Jrimbha, Tapa

2

Rakta

Ushna, Pidaka, Trishna, Sarakta Sthivana, Daha, Raga, Bhrama, Mada, Pralapa

3

Mamsa

Antardaha, Trishna, Moha, Glani, Srista Vitkata, Daurgandhya, Gatra Vikshepa,

4

Meda

Tivra Sweda, Tivra Pipasa, Pralapa, Abhikshna Vamana, Svagandhasya Asahatvam, Glani, Arochaka,

5

Asthi

Virechana, Vamana, Asthibheda, Prakujanam, Gatra Vikshepa, Shvasa,

6

Majja

Hikka, Maha Shvasa, Kasa, Atitama Darshana, Marmachheda, Bahishaityam, Antardaha

7

Shukra

Shukra Moksha and Mrityu

 

Table 6.5: Management of Jwara at level 2 as per Dhatugata Avastha7

Sl No

Dhatu

Management

Kalpas

Panchakarma

 

1

Rasa

Rasa Pachaka, (Kalinga, Patola Patra, Kutaki)

Vamana, Upavasa

2

Rakta

Rakta Pachaka (Patola, Sariva, Musta, Patha, Kutki)

Seka, Pradeha, Samshaman

3

Mamsa

Nimba, Patol, Triphala, Draksha, Musta, Kutaja

Vireka, Upavasa

 

4

Meda

1. Kiratatikta, Guduchi, Chandana, Shunthi.

2. Mahaushadhadi Kwath (Shunthi, Guduchi, Musta, Chandana, Ushira, Dhanyaka)8

Vireka, Upavasa

5

Asthi

1. Guduchi, Amalaka, Musta,

2. Vasadi Kwath (Vasa, Dhatri, Pathya, Nagara)9

3. Pathyadi Kwath (Haritaki, Shaliparni, Shunthi, Devdaru, Amalaki, Vasa)10

Niruha and Anuvasana Basti

6

Majja

Niruha and Anuvasana Basti

7

Shukra

 

 

Investigation: Same as Level 1

  1. Widal test
  2. Urine – culture and sensitivity
  3. Sputum
  4. Mantoux test
  5. X-ray Chest PA view

Treatment: In addition to the management mentioned in Level 1, following drugs may be added as per the requirement and status of the patient.

 

Table 6.6: Medicines at level 2 for Jwara

Drugs

Dosage form

Dose

Time of administration

Duration

Anupana

Pathyadi Kwatha (in Sama Jwara of more than 8 days)

Kwatha

10-30 ml

Before meals once daily

Upto 8 days

-

Sanjivini Vati11

Vati

1-2 tab

Before meal / thrice daily

1-2 weeks

Warm water

Amrutottaram Kwatha12

Kwatha

20-40 ml

Before meal / thrice daily

1-2 weeks

-

Amritarishta13

Arishta

10-20 ml

Before meal / thrice daily

1-2 weeks

Equal quantity of water

Tribhuvanakirti Rasa Vati14

Vati

125-250 mg

Before meal / thrice daily

1-2 weeks

Water / Madhu

Ananda Bhairava Rasa15

Vati

125-250 mg

Before meal / thrice daily

1-2 weeks

Water / Madhu

Jayamangala Rasa16

Vati

125-250 mg

Before meal / thrice daily

1-2 weeks

Water / Madhu

 

Note: Sanjivani Vati is specifically indicated in Amavastha of Jwara, Jayamangala Rasa in Sannipatika Jwara. Tribhuvanakirti Rasa is specifically indicated in Shlaishmika Jwara and Ananda Bhairavarasa in Jwara with Atisara.

 

 

Pathya - Apathya (Diet and life style): Same as Level 1.

Referral Criteria: Patients not respond­ing to Level 1 and 2 shall be referred to Level 3.

 

LEVEL 3: AYURVEDA HOSPITALS AT INSTITUTIONAL

LEVEL OR DISTRICT HOSPITAL/ INTEGRATED AYURVEDIC

HOSPITALS

Clinical diagnosis: At this level, confirma­tion of various advanced or acute fevers can be done and accordingly wherever needed, the following medicines can be started as per the type of fever.

 

Table 6.7: Comparative features for various type of Jwara

Fever type

Dengue

(Sannipataj Jwara)

Malaria

(Vishama Jwara)

Influenza

(Vata-Shlesmika Jwara)

Symptoms

Sudden-onset fever, headache, muscle & joint pains, and rashes

Fever with rigor, fatigue vomiting and headache.

In severe cases it can cause seizures, coma or death.

High fever with chills or sometimes with rigor, runny nose, sore throat, muscle pain, headache, coughing, watery eyes with irritation and feeling of tiredness. Occasionally there may be nausea and vomiting.

Differential diagnosis

Malaria, leptospirosis, viral hemorrhagic fever, typhoid fever, meningococcal disease, measles, influenza, Swine flu, Congo fever

Dengue, typhoid fever, influenza, measles,

Rhinitis, initial stage of dengue fever, typhoid fever

Clinical diagnosis

The diagnosis of dengue is typically made clinically, findings of fever plus any two of the symptoms from nausea & vomiting, rash, generalized pains.

Signs: positive tourniquet test, (>10 patches / inch2)

Cyclic occurrence of sudden coldness followed by shivering, fever and sweating.

Symptoms including fever with chill (Sheet Purvaka Jwara), running nose (Nasa Srava), sore throat, headache (Shirahshoola), muscle pain (Angamarda), coughing (Kasa), no desire to have food (Aruchi), watery eyes (Nayanaplava), and lethargy (Klama)

 

 

Investigations

1. Virus isolation in cultures by PCR (Polymerase Chain Reaction) - Day 1st to 5th

2. Viral antigen detection (such as for NS1) – Day 1st to 7th

3. Serological tests: IgM &, IgG (2nd ) – Day 4th onwards

IgG (1st) – Day 7th on wards

1. Peripheral smear for malarial parasite

2. Rapid slide method (Antigen based diagnosis) to confirm malaria and its type.

3. Urine -Routine, Microscope, Bile salt & Pigment – to rule out presence of black water fever and presence of jaundice

LFT, RFT and EEG may be done to assess the status of organs.

To precise the type of flu like swine flu (H1N1) or bird flu (H5N1) below mentioned investigations are carried out:

1. Polymerase chain reaction (PCR)

2. Viral culture from nasal, pharyngeal, or throat aspirates.

3. Serology

Treatment

On the line of Vata-Pittaja Jwara

On the line of Sannipatika Jwara considering Dhatugatavasta

On the line of Vatashlaismika Jwara

 

Table 6.8: Medicines for Dengue fever

Drugs

Dosage form

Dose

Time of administration

Duration

Anupana

Remarks

Kalingadi Kashaya17

Kwatha

20-40 ml

Before meals / twice a day

5-7 days

---

Patoladi Kwath18

Kwatha

10-20 ml

Before meals / twice a day

1 week

Honey

Truna Panchamoola Kashaya19

Kwatha

40 ml

2 to 3 time

5-7 days

---

Acidosis condition

Praval Pisthi

Churna

250mg

Twice a day

5 days

Gokshura kashaya

Acidosis condition

AkikaPishti20

Churna

250-500 mg

Twice a day

5 days

Madhu / Gaudugdha

If bleeding present

Bhoonimbadi Kwatha21

Kwatha

12–24 ml

Twice a day

5 days

Madhu

Elevated PT, OT level, bleeding condition

                       

 

Table 6.9: Medicines for Influenza

Drugs

Dosage form

Dose

Time of administration

Duration

Anupana

Sudarshana Churna22

Churna

2-4 gm

2 to 3 time

3 days

Warm water

Tribhuvankirti Rasa23

Vati

125-250 mg

Twice a day

3 days

Madhu, fresh Ardraka Swarasa, Tulsi Patra Swarasa

Naradiya Laxmi Vilasa Rasa24

Vati

250 mg

2 to 3 time

3 to 4 days

Tambula Swarasa

Jwaraghni Gutika25

Vati

1-2 tab (250mg)

Twice

3 to 5 days

Guduchi Swarasa

Talisadya Churna26

Churna

3 gm

Three time

1 week

Madhu

Chandramrit Rasa27

Churna

250 mg

2 to 3 time

1 week

Madhu, Ardraka Swarasa, juice of Vasa leaves

Shrungyadi Churna28

Churna

250 mg. to 1 gm

Three time

1 week

Madhu

Karpuradi Churna29

Churna

1 to 2 gm.

Twice

3 to 5 days

Madhu

Jwarahara Kashaya30

Kwatha

40 ml

Twice

10 days

----

Barihat Kasturi Bhairava Rasa31

Churna

125 mg

1 to 2 time a day

2 to 3

Ardraka Swarasa, Madhu

Mrutyunjaya Rasa32

Churna

125 mg

2 time a day

3 to 5 days

Fresh ginger juice, Madhu

Laxminarayana Rasa33

Churna

250 mg

Twice a day

3 to 5 days

Madhu, Tambula Swarasa

 

Table 6.10: Medicines for Malaria

Drugs

Dosage form

Dose

Time of administration

Duration

Anupana

Tulasi Swarasa34

Swarasa

5-10 ml

Twice or thrice a day

3 to 5 days

Trikart Churna + Madhu

Sudarshana Ghanavati

Vati

1-3 Vati (250-500 mg)

Twice or thrice a day

3 to 5 days

Luke warm water

Kshudradi Kwatha35

Kwatha

20-40 ml

Twice a day

3 to 5 days and more if needed

Water

 

Bhunimbadi Kwatha36

Kwatha

20-40 ml

Twice a day

15 days

Water

Ayush 6437

Vati

4 Tab

(500 mg)

Twice a day

5 to 7 days

Water

Kirata Tiktakadi Kwath38*

Kwatha

20-40 ml

Twice a day

15 days

Water

Vishama Jwarantak Lauha39**

Churna

125 mg

Twice a day

15 days

Madhu

Sarva Jwarahara

Lauha40

Churna

125 mg

Twice a day

5 to 7 days

Madhu

Jayamangal Rasa41

Churna

125 mg

Twice a day

7 days

Madhu/Guduchi Swarasa

Brihat Kasturi Bhairava Rasa42***

Churna

125 mg

Twice a day

3 – 5 days

Madhu, Ardrak Swarasa

Vardhaman Pippali Prayoga43**

Pippali processed in milk

0.5-5gm

(daily dose changes)

Once in morning

21 days

                   

 

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