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
- Widal test
- Urine – culture and sensitivity
- Sputum
- Mantoux test
- 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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