147 - Diseases 

The chapter mentions the names of severs which attack elephants, horses, dogs, cloud, water, herbs and earth. 

Dhanvantari said: 

1. I shall explain the pathology of fevers for a thorough understanding of all types of severs. The infuriated Rudra at the destruction of sacrifice of Daksha cast a fiery look from his third eye in the forehead from whence fever originated. In the medical science it is known as Rogapati (lord of diseases); Papma (sin), Mrutyuraja (king of death); Ashana (the devourer) Antaka (the finisher). 

2-3. It is caused by unhygienic misconduct, it produces delirium, unconsciousness and harassing rise in temperature. This cruel affliction is found in all sorts of animals and even in inanimate objects. In elephants it is called Pakala² or Kutapakala or Hastivatajvara: In horses Abhitapa. In dogs Alarka. In clouds Indramada. In water Nilika. In herbs Jyotis (fluorescence). In soils Ushara (saline and barren). 

2. Pakala is a fever which attacks elephants. This is tenfold. Kutapakala is the deadliest of all fevers and kills elephants at once. For detail sec ch. 9 of the Hastyayurveda of Palakapya. 

4. In the fever due to derangement of Kapha the indications are hiccough, Vomiting sensation, Chatarrh, stiffness and rigidity of the body, coldness of the skin and pain in every limb. 

5. As days pass, these symptoms are seen operating and increasing. Non-application of proper remedies or application of contrary remedies may aggravate them. 

6-7. The characteristic symptoms in Amajvara³ (in fever due to constipation) are: -Loss of appetite, indigestion, rigidity of the body, lethargy, burning sensation in the heart, a reverse or relapse, drowsiness and lassitude, abdominal bruises, ill functioning of the humours, salivation, hiccough, loss of hunger, moistness in the mouth tasting sweet, a transparent glossiness of the skin, temperature, heaviness of limbs, profuse urination and neither digestion nor exhaustion. 

3. GP mentions fever with or without constipation and the fever sannipata caused by the disturbance of the three humours. 

8. In the Niramajvara (fever without constipation) there is emaciation due to hunger, a lightness is felt in the limbs, abatement of temperature and relapse in eight days are the symptoms. When there is the admixture of different types of fever the characteristic symptoms of every one are seen. 

9. The Vayu principle in combination with the principle of Pitta brings about a type of fever when the following symptoms are seen: Headache, swooning, vomiting, burning sensation in the body, parchedness of throat and mouth, aching in the joints, insomnia, agitation, horripilation, yawn and perpetual prattle. 

10. In the sever due to the derangement of both Shleshma (phlegm) and Vayu (gas) the symptoms are: fall of temperature, loss of appetite, pain in the joints, headache, difficulty in breathing, frequent coughs, discoloration of the skin, pallid face, sluggishness, chillness, sensation of darkness, whirling of the head and lassitude. 

11. In the fever due to the derangement of both Shleshma and Pitta humours the symptoms are: -chillness, rigidity, profuse perspiration, burning sensation, unsteadiness, thirst, coughing, vomiting of bile and phlegm, stupefaction, drowsiness and bitter salivation. 

12. When all the deranged humours combine in producing a fever it is called Sannipata Jvara or Abhinyasa Jvara. where the symptoms mentioned before are present. In addition to these there are other symptoms such as: -Burning sensation and chillness in alternation, vertigo sleeping in the day and wakefulness at night. 

13. The patient either sleeps always or does not sleep at all; sometimes he perspires profusely or never at all. He sings, dances and laughs. Natural functions of the body cease. 

14. Eyes become red hot, sunk in the sockets and full of tears. The eyelids droop down. There is pain in the calves, sides, joints, head and in the bones. Dizziness is felt. 

15. Ringing in the ears with acute pain, great chilliness or no chilliness at all alternately; the tongue appears burnt and rough. The joints seem to crackle and appear loose and heavy. 

16. Blood-streaked bilious matter is vomited, the head begins to roll and toss. Excessive thirst is experienced; The rooms appear to be dark and brownish red and ringlets appear before the eyes. 

17. Pain is felt in the heart. Loose motions or coming bit by bit. Chilliness of the face, debility, loss of voice, and delirium. 

18. Development of the humours, a long drowsiness, a diffused croaking sound in the throat. These are the indications in Sannipata Jvara known as Abhinyasa Jvara also. The Ojas or vitality in the body becomes fully spent. 

19. The gaseous humour (Vayu) being held at the throat the bilious principle suppressed within tries to come out due to its expansive nature. Hence the eyes appear yellowish in colour in a patient of Sannipata Jvara. 

20. The Sannipata jvara wherein the doshas become excessively aggravated and the gastric function is impaired is incurable. Other types of Sannipata fevers can be cured with great difficulty. 

21. There is another type of Sannipata jvara where the Pitta humour remains aloof and produces burning sensation in the skin or in the viscera either before or after the onset of fever). 

22-23. In the Sannipata Jvara due to Vayu and Kapha the chillness, burning sensation, etc, are felt more acute. When Kapha in fluid state is dried up by the pitta and when pitta subsides later, swooning, intoxication and thirst result. If there is burning sensation at the beginning and somnolence and lassitude in the end, vomiting is the result. 

24. The Agantu (i.e., casual fever due to extraneous causes) fever is of four types (1) due to hurt or blow, (2) due to contact, (3) due to curse, (4) due to black magic. If there is fever, due to burns or scalds it comes under the class Abhighataja i.e., the first type. 

25. If there is fever due to exhaustion, the wind principle contaminates the blood. There is pallor, pain and rise in temperature and swelling too. 

26. Malignant planets, narcotics, poisons, anger, fright, sorrow and love may cause fever. This may be classified under the casual type but the special characteristics will be spasmodic laughter and cries. 

27. In the fever due to inhalation of drugs and narcotics, fainting, headache, vomiting and sneezing are the special symptoms. The fever due to poison generates swooning, dysentery, darkness and discoloration of the skin, burning sensation and vertigo. 

28. The fever due to anger has the special symptoms of tremulousness and headache; that due to fright and grief is signified by perpetual prattle. 

29. The fever due to lust and love is marked by dizziness, loss of taste for food, burning sensation, extreme shyness, loss of sleep and absence of firmness of mind and courage. 

30. In the fever due to adverse planets as in the Sannipata Jvara both the gaseous and bilious principles are aggravated. 

31. The fevers due to curse and black magic are considered to be very terrible and unbearable. The mantras and incantations of black magic excite the victim and harass him. 

32. Here and there in the body eruptions appear. The patient feels giddy. There is burning sensation and swooning in the end. The fever rises every day. 

33-34. Such are eight¹ types of fever. In brief, they are of two kinds, viz. physical and mental; mild and virulent; internal and external; Prakruta (Natural i.e., Seasonal) and Vaikruta (unnatural or sporadic); curable and incurable or mature and immature. In the former, the fever is in the body and in the latter it is in the mind. 

1. Besides the eightfold division of fever, there is a twofold division of six kinds, viz Sharira-manasa, saumya-tikshna, antar-bahir ashraya, prakruta-vaikruta saddhya-asadhya, and sama-niramaya. 

35-36. When Vayu principle is in combination with Kapha principle there will be chilliness. There will be burning sensation if it is in combination with Pitta. A mixture of these two when the doshas are mixed. If the fever is within, the disorder and deterioration is internal and there will be constipation. In the case of external fever there may be loose motions. The fever is curable. 

37. In the rainy season a fever due to the derangement of Vayu is Prakruta; still, this is generally incurable. Fevers due to the derangement of the other two in the rainy season are Vaikruta and definitely incurable. 

38. In the Autumn a fever due to derangement of Pitta is Prakruta, otherwise it is Vaikruta. 

39-40. In the spring, a fever due to the derangement of Kapha is Prakruta, otherwise it is Vaikruta. All Vaikruta fevers are incurable. Vayu deranged in the rainy season causes fever with the combination of Pitta and Kapha. Pitta deranged in autumn causes fever with the support of kapha. Due to its nature and discharge there is no danger in fasting. Kapha deranged in Spring causes fever with the support of Vayu and Pitta. 

In strong persons with less defects fever does not cause much harm and hence is curable. If the doshas are all altogether aggravated it is incurable. 

41. The characteristic sign of an Amajvara is immature virulence of fever), low functioning of the gastric fire, excessive urination, non-functioning of the digestive and excretory systems and loss of hunger. 

42. The characteristic sign of a Pachyamana (or ripening or maturing) fever is virulence of fever, excessive thirst, prattling and delirium, rapid breathing, vertigo, loose motions and acute pain. 

43. Since digestion is possible by the removal of the Ama matter, a seven days fast is recommended in this case. Jvaras are classified into five taking into consideration the extent of derangement in the malas (humours), the periodicity or the season of attack and the comparative strength or weakness of the patient or the exciting factors. 

44. Generally when there is a combination of many factors these fevers are produced. They are Santata, (remittent) Satata, (intermittent), Anyedyu (appearing on every other day), Trutiyaka (tertian) Chaturthaka (occurring once in four days). 

45-46. The doshas pervading the ducts and vessels carrying the seven dhatus, urine and faeces distress the entire body and get aggravated on equal sight (?) etc. The Rasas or secretions are strong or weighty due to the special characteristics of the body. Always they make the fever unbearable, having no antagonist. 

47. It may alleviate the doshas, fever, heat or the dhatus by means of purity or impurity. 

48. Generally it reaches the limit either for complete abatement or for finishing (the patient) in seven, ten or twelve days in the case of Vayu, Pitta and Kapha respectively. 

49. This is Agnivesha's¹ opinion. According to Harita the crucial days are twice seven (fourteen), ninth and eleventh This is the line of demarcation for the three doshas either for abatement or for finishing the patient. 

1. The Purana's reference to Agnivesha and Harita in chapters on Ayurveda indicates that the ayurvedic section of the Purana is based on authority and is therefore authentic.

50-51. Based on purity or impurity the duration of the attack may be more. If lean persons contract disease and do not observe rules of diet and conduct, even a slight aggravation of the deranged dosha, strengthened by the support of other exciting factors may become fatal. 

52. The dosha increasing or decreasing irregularly will cause fever in its own time. 

53. The doshas being weakened, the fever subsides due to the powerful antidotes (by way of medicines) and its subtle form gets merged in the secretions. 

54. With the absorption of fever emaciation, pallor and sluggishness vanish and its spreading in the whole of the body is checked since the dilation of the excretory vessels helps them to be thrown out through natural outlets. 

55. The Santata is remittent fever. The Satata (intermittent) is contrary to it since its beginning is irregular though it becomes acute during the night. 

56. Generally, the morbid humour getting mingled in blood produces the Satata type of fever. The Anyedyu type of fever comes at the time of the juncture of day and night. 

57. In this fever, vessels containing fleshy matter and fat substance are contaminated. Due to the combined action of Pitta and Vayu there is pain in the head. Due to Kapha and Pitta there is pain in the Trika (Spine). 

58. Pain in the back is due to the combined action of Vayu and Kapha. This fever subsides for a day in the middle. In the sever Chaturthaka the fat, marrow and the bones are contaminated by the Doshas. 

59. The Chaturthaka fever confined to marrow alone manifests twice a day. Due to Kapha affection there is pain in the knee-joint, and calves, while affected by Vayu the head also aches in the beginning. 

60. The Chaturthaka-viparyaya fever confined to bones and marrow continues for three days and subsides on the fourth day. 

61. The derangement of the humours aggravated by unsuitable diet and activities being matured due to non- elimination) the patient must be compelled to fast for seven days. 

62. The mind and the bodily functions of the patient are affected by the fever. This Chaturthaka fever is incurable because it has entered deep into the ducts of Dhatus (the seven primary constituent elements of the body), and the doshas have risen up all simultaneously and attained equal heights of virulence. 

63-67. In the case of all these subtle attacks of fever the deranged humour traverses slowly along the vessels of blood, etc and since it takes a long time to cover the whole body it does not harass the body much. But if medication ceases the fever may be acute and nighty paroxysms of pyrexia may be witnessed. As the physical strength of the patient becomes less and less, the fever slowly permeates the whole of the Rasa constituents of the body. Then the dosha (deranged humour or diathesis) becomes aggravated sooner or later resulting in high fever. 

68. Just as a seed in the soil when watered well does not take time to sprout so also the seeds of doshas sprout into fever. 

69. Just as poison taken in becomes virulent and fatal so also the doshas getting strength from other factors become aggravated. 

70. Thus, the fevers Vishama, Satata, etc. function. The characteristic symptoms when the fever is confined to Rasa constituent of the body (Lymph) :-Disquietude (or sea sickness), heaviness, dejection, shooting pain in the limbs, yawning, loss of taste, vomiting sensation, difficulty in breathing, etc. 

71. When the fever permeates the blood, the symptoms are: -Spitting of blood, excessive thirst, appearance of coarse hot eruptions on the skin, red patches, burning sensation, vertigo, intoxication and prattling delirium. 

72-74. When the fever is restricted to the flesh, the symptoms are thirst, fatigue, defiled splendour, an internal burning sensation, dizziness, appearance of darkness, fetidness and jerky movements of the limbs. When the fever has permeated the fat, the symptoms are perspiration, excessive thirst, vomiting, foul smell and irritability. When the fever penetrates the bone the symptoms are delirium, exhaustion, loss of taste and appetite and pain in the bones. 

75. When the fever permeates the marrow the symptoms are the functioning of the doshas, dyspnea (difficulty in breathing), convulsive movements of the limbs, croaking sound in the throat, burning sensation within, chilliness outside, deep sighs and hiccough. 

76. When the fever permeates the semen virile, the symptoms are appearance of darkness, splitting of the vulnerable joints, numbness of the penis, and death when seminal egress takes place. 

77. These five types of Chaturthaka Viparyaya fever are more and more difficult to treat as enumerated above. The Pralepaka type of fever exhibits the symptoms of delirium, chilliness, low temperature and heaviness of the limbs. One feels as if one's body is coated with phlegm. 

78. The Angabalashaka (Devourer of the strength of limbs) type of fever exhibits the symptoms of low temperature, coarseness or stiffness of the body, numbness of limbs and difficulty in walking. Phlegm will be profusely manifested. 

79. If the wine passed is of the colour of the cut piece of turmeric the fever is called Haridraka (yellow fever?). It is fatal. 

80. Where the patient is deficient in Pitta and, Kapha and Vayu are equally dominant there is no fever during the day but there is fever at night. This type is called Ratrijvara or Paurvaratrika. 

81. The onset of fever is at nightfall since due to the action of Vayu the body gets dried up in the Kapha content either by means of exercise or due to the action of Sun's rays. 

82. When Kapha and pitta are in the abdomen the upper part of the body remains cold but the lower part remains warm. 

83. But when Kapha goes lower down, the Pitta remaining in the upper region, the body is felt warm and the lower part chill (at the hands and feet). 

84. The fever confined to the lymph and blood vessels can be cured. So also the fever that is restricted to flesh and fat. But the fever affecting bones and marrow is incurable. At the onset of fever, the different limbs are discoloured rendered pallid. 

85. The patient attacked by fever sometimes becomes unconscious. He has an appearance of an angry man. He evacuates hot mucuous and bilious matter very frequently. 

86. The characteristic signs of a patient freed from sever are lightness of body and exhaustion; delusion and heat disappear, some eruptions in the mouth, freedom from pain, natural functioning of the sense organs, perspiration, sneezing, mind at rest, appetite and itching sensation on the head.