1 Introduction

The references to fevers (jvara) can be traced right from the period of veda and purāṇa and are extensively mentioned throughout. The causes of its occurrence and the treatments are mentioned in different contexts and this gives jvara a historical importance (Prasad, 2001). All the canonical Ayurvedic treatises like Caraka Saṁhitā (Acharya, 2013, p.193), Suśruta Saṁhitā (Acharya, 2007a, 2007b, p.670), Aṣṭāṅga Hṛdaya (Paradakara, 2016, p.543) and Aṣṭāṅga Saṅgraha of Vāgbhaṭa also give utmost importance to jvara and have dealt with very elaborately. Jvara is considered to be the most prime of all the diseases (Paradakara, 2016, p.447) which invariably afflicts all the age groups of people. Even though jvara as a disease is described in detail, the description of sannipāta (a manifestation of jvara caused due to vitiation of tridoṣas) are very limited (Panja et al. 2011) and this condition also happens to be the most difficult forms of jvara to be treated. The elaborate “tridoṣaja prakaraṇa” being the prime section, Jvaranirṇaya deals extensively about the signs and symptoms of various types of sannipāta jvara in 241 verses out of 365 in total. There are hardly any other known Ayurvedic treatises which discuss this aspect in such detail.

Jvaranirṇaya (Pandita, 1963) is a manuscript of a monograph in Devanāgarī lipī in complete and available in readable form. Monographs in Ayurveda are very rare and it is usually a spectrum of diseases or systems which are included as a whole in the composition of treatises in Ayurveda. For example, the Caraka Saṁhitā encompasses the spectrum of diseases which are related to general medicine (kāya cikitsa pradhāna), where as Suśruta Saṁhitā mainly deals with diseases related to the domain of surgery (śalya tantra pradhāna) and Kāśyapa Saṁhitā (Sharma, 2019) chiefly deals with paediatric, gynaecological and obstetric conditions (bāla & strī roga).

Therefore, these unique features of the monograph make it worth exploring. Moreover, this paper monograph is not translated into any language nor is critically analysed and remains out of print. Hence, it becomes imperative that this monograph  be worked on to bring out distinct aspects of the treatise. This will in turn help in contributing to the literary richness of Ayurveda and for better readership.

2 Historical account

The author of Jvaranirṇaya, Sri Nārāyaṇa Paṇḍita is known to be the disciple of Nāgeśa and the son of Kṛṣṇa Paṇḍita. He is also identified to be the younger brother of Nāganātha who was one of the teachers of Lakṣmaṇa Paṇḍita who wrote Nidānapradīpa (Meulenbeld 2002). Sri Nārāyaṇa Paṇḍita is also the author of Vaidyavallabhaṭīkā and Siddhāntasaṃcaya which are the commentaries of the texts Siddhāntacikitsā and Śārṅgadharā’s Triśatī respectively (Meulenbeld, 2002, p. 265). The time period of this treatise is corroborated to be sixteenth century CE from the fact that Sri Nārāyaṇa Paṇḍita has written a commentary for Śārṅgadharā’s Triśatī on jvara which was written in fifteenth century CE. The treatise Jvaranirṇaya was published for the first time by Kerala Viśvavidyālaya, Anaṅtaśayana Gṛnthāvalī by Sri. K Raghavan Pillai (Pandita, 1963). The available text is a printed copy of the manuscript published in 1963 completed/published on Pauṣa śuddha dvitīya as mentioned on it. Looking into other popular contemporary works of the period, it may be inferred that it was a time when many commentaries for various classical treatises were being written. It was also a time of a major evolution happening in Ayurvvda with a trend to concise and simplify the voluminous texts. Texts like Śārṅgadharā Saṁhitā (Shastri, 2013) and Mādhava Nidāna (Tripathi, 2006) were being composed by compiling aspects from various texts. This treatise is one such compendium on jvara which incorporates the aspects from various other texts along with the author’s way of thinking.

3 Presentation and core content of the text

The main sources of this text are Caraka Saṁhitā, Suśruta Saṁhitā, Aṣṭāṅga Hṛdaya/Saṅgraha of Vāgbhaṭa. The opinions of various authors and texts are mentioned in different contexts throughout like Bhālukī (Bhāluka Tantra), Ćaraka, Jējjata, Khāranādi, Mādhava, Munī (Vāgbhaṭa), Nāgabhartar, Ṛṣi (Vāgbhaṭa), Sāmpradayikaḥ, Suśruta, Tāntrikaḥ, Tārkikaḥ, Vāgbhaṭa, Vṛddha Suśruta apart from his own opinion. It is an exclusive text on classification of clinical features of different types of fever and contains five sections in total (Table 1).

Table 1 Sections and contents of the MS
Full size table

The most striking feature of this text are the separate chapters devoted for the description of fevers caused due to single doṣa (ekadoṣaja), fevers with predominance of two doṣa (dvidoṣaja), the sannipāta (involving three doṣa/tridoṣaja) and fevers due to extrinsic causes (āgantūja). The sannipāta is described in great detail with 241verses and is the largest among all the sections. The clinical signs, prognosis and signs of imminent death are also described for certain specific types of fevers in the text.

3.1 Upōdghāta prakaraṇa

This is the introductory section of the manuscript which deals with the evaluation of the disease (roga parīkṣa) with the help of six evaluating factors (ṣaṭ nidāna) emphasising upaśaya (relieving factors), a component of diagnosis looking at how the body responds to an administered diet, medicine or lifestyle which is elaborated in detail.

Key topics dealt: There is a mention of anupaśaya (factors antagonistic to upaśaya), as the sixth cause (nidāna) – “śaṣto anupaśayam” [4]. The causes for endogenous fevers (nija jvara) are explained in different stages like stage of accumulation of doṣa (doṣa sanćaya), stage of vitiation (prakōpa), stage of spread (prasāra), stage of localization (sthāna samaśraya), stage of expression of symptoms (vyakti), stage of differentiation (vheda). These six are called the movement of doṣa (vātādīnām gati) [5]. It is mentioned that in the stage of ćaya, there is dislike towards similar attributes (guṇa) and liking/affinity towards dissimilar guṇa [7]. This feature is exhibited in mild (hīna) form, in the stage of prakōpa it is in moderate (madhyama) form and in the stage of Prasāra it is in severe (vṛddha) form. There is a mention that the diseases which manifest without the specified order of events are known as exogenous (āgantu) [11]. Upaśaya is explained with the details of medicines (bheṣaja), diet (āhāra) and lifestyle modification (vihāra). These are explained with examples of diseases like rhinitis (pratiśyaya) [18], diarrhoea (atisāra) [20], fever due to pitta predominance (pittaja jvara) [22], psychosis (unmāda) [24], fever due to kapha predominance (slēṣma jvara)[26], burns (vanhipluṣta) [29], rheumatic type of fever (āḍhyavāta) [30], fever with predominance of coldness (śīta jvara) [31].Footnote 1

3.2 Pŕthakjāta prakaraṇa

Pŕthakjāta here means “caused by single doṣa (ēka doṣa) specifically”. The cause (nidāna), prodromal symptoms (pūrvarūpa), symptoms (lakṣaṇa) and types that manifests due to the involvement or vitiation of a single doṣa, two doṣa, three doṣa and fever due to extrinsic causes (āgantu) are mentioned in this section. This section also deals with latent fevers (viṣama jvara) and the time taken for relief from different types of fevers.

Key topics dealt: It is mentioned that the cause for the manifestation of a disease is the faulty usage (mithyā yoga), excessive usage (atiyoga) of food and/or lifestyle. It could also be due to sinful acts (pāpa karma). Along with this, pathogenesis specific to a disease (viśeṣa samprāpti) is also mentioned [10]. General prodromal symptoms (sāmānya pūrvarūpa) and specific prodromal symptoms (viśeṣa pūrvarūpa) on the basis of doṣa are mentioned and the opinion of tārkikaḥ is also mentioned [21]. Santata, śuddha santata, śhuddha pratyāhika [40] are the three types of jvara caused due to vāta.

3.3 Dvandvaja prakaraṇa

This section is called “dvandva” because it deals with explanations mainly of the combination of two doṣa. The section starts with the explanation of prakṛti sama samaveta/hetu guṇa/ samavāya and vikṛti viṣama samaveta/hetu anānurupa guṇa/ viśeṣa (ayurvedic concepts of understanding the heterogeneity of patterns in a same disease).

Key topics dealt: Dvandva are of two types; samavāya and viśeṣa like hetu anurūpa and hētu anānurūpa, prakṛti sama samaveta is samavāya and vikṛti viṣama samavēta is viśeṣa. This part is not very clear as to what is exactly indicated, and needs further analysis [1–2]. The author explains the concept of vātapitta, slēṣmavāta, vātaslēṣma, slēṣmapitta, pittaslēṣma [7–18] (dvandvaja jvara) with the help of “śṛṅgagrāhika nyāya” (a maxim which means to hold the horn of a cow or an ox to point a particular one from the others in a herd). The references of Suśruta [19] and Jējjata [20] are quoted in the context of describing the ‘dvandva’ section. But interestingly, the author has mentioned their opinion in the main verse itself without giving a verse number. The author gives his opinion at the end in these contexts.

3.4 Tridoṣaja prakaraṇa

This section deals with types of sannipāta which are mostly mentioned by Vāgbhaṭa. Apart from this, it also deals with fevers affecting various dhātu (dhātugata jvara) and the strength/severity of each of them (balābala).

Key topics dealt: The author mentions that this section is similar to the explanations of Vāgbhaṭa [16]. Suśruta’s opinion is mentioned in the context of prakṛti sama samaveta [36]. The concept of vikṛti viṣama samaveta lakṣaṇa is mentioned to be taken from Vāgbhaṭa [41]. Unique terms such as ojovisṛamsa [55], ojonirodha [57], ekapakṣābhighāta [59], sammohana sannipāta [60], karkotaka sannipāta [71], vaidārika sannipāta [78], rauti sannipāta [82], paphaṇa sannipāta [90], viddhaphala sannipāta [95], makara sannipāta [98], kōṭapalaka sannipāta [100] are mentioned and has also referred to Vṛddha Suśruta in this context [102]. Names and symptoms of jvara which are uncommon such as bhūtah [109], antardahārdhita [113], bhramākhyam [124], sandhigam [125], karnikā [127], kānthakōn̄ja [129], jihvakākrānta [130], taṇḍrika [132], pralāpaka [133], raktaśtīvi [134], śītagātra [135], abhinyāsa [136], pralepaka [144], vātabalāsaka [145], nāgabhartra [166], āditya [168] are mentioned. Opinions of Vāgbhaṭa and Mādhava are mentioned in the context of types of sannipātaja jvara [153]. Similes for a type of jvara like ‘narasiṁha and ardhanārīśwarā’ are mentioned [158]. Deranged movement/flow of vāta (pavana gati viṣamya) is mentioned as the cause for viṣamajvara [161]. Jējjata’s opinion on the pattern of fever is mentioned [176]. In the context of dhātugatatva, the author mentions that some other authors opine kshīṇa doṣa to be the cause for dhātugatatva [184]. Doṣa affecting particular dhātu like vāta for asti; pitta affecting sveda, śonita, majja, māmsa, rasa, meda; kapha affecting śukra, oja, mūtra and viṭ is mentioned [200]. Factors influencing the balābala of jvara are mentioned in terms of doṣa, anna, ćeśta, deśa, sthāna and karma and few examples are also sighted [202]. Patterns of satata, anyadyuśka jvara as opined by “other authors” are mentioned [214]. It is mentioned that both prākṛta or vaikṛta jvara start from rasa [217]. It is mentioned that ‘some’ classify the dhātugata jvara on the basis of liṅga which is soumya or tīkṣṇa [227]. Description about pakśika jvara is also mentioned [235].

3.5 Āgantuja prakaraṇa

This is an exclusive section on extrinsic fevers (āgantu jvara) which explains about the types, symptoms (lakṣaṇa), prognosis (sadhyāsādhyata) and omen (ariṣṭa lakṣaṇa) related to it.

Key topics dealt: It is mentioned that in āgantuja jvara, manah tāpa happens first [14]. It is also mentioned that these fevers are difficult to diagnose and treat for even a vṛddha vaidya because they are grave (gambhīra) and manifests with a feeling of heat inside the body (antṛdāha) and excessive thirst (tṛṣṇa) [19]. Ariṣṭa lakṣaṇa related to jvara are also mentioned [26]. At the end, the author mentions his name and year of composition [36].

4 Discussion and conclusion

Looking into the methodology employed Jvaranirṇaya looks like a compendium on jvara written in a simple language and composed in padya form. The topics are well classified under specific sections and in certain contexts the author mentions the opinion of other authors and concludes with his own opinion on the same. Simple examples are given to explain the concepts but the author has mainly focussed on the symptomatology rather than the treatment throughout the text.

Being a monograph, it covers all the different classifications on jvara based on dōṣa and those caused due to extrinsic causes (āgantu).Though the treatise does not discuss the treatment aspects, it briefly touches upon certain principles of treatment. It appears that the author emphasises more on the diverse presentations caused due to the permutation and combination of doṣas and thus has presented the text focusing on it. This could be because there were other contemporary texts available which focussed exclusively on the aspects of medications and treatments and this work would aid in fine tuning it. The verses match to Caraka saṁhitā, Suśruta saṁhitā, Aṣṭāṅga Hṛdaya/Saṅgraha in certain contexts of this text but the author has also modified the verses in most of these contexts by additionally adding his own versions to the borrowed ones. There are also verses which are purely contributed by the author himself in the text. However, this is elicited by going through the text in general and noting the observations. A thorough analysis is required to exactly state the original contribution of the author and the content borrowed from other texts.

The explanations of sannipāta jvara along with the prognosis are dealt with very elaborately with 241 out of 365 verses devoted to it. This kind of detailing is not seen in any of the main treatises of Ayurveda. At around the late medieval time period (between thirteenth and sixteenth century CE), treatises with similar approach are known to have been written focussing on conditions with sannipāta doṣa. One such treatise is Aśvini Saṁhitā which has a separate section named sannipāta kalikā (Sharma, 1981, p. 337). This gives a clue that around these times, there was an emergence of newer and more complex diseases along with the prevalence of pandemics (Piret & Boivin, 2021) which compelled the authors to focus on such areas. Even the contemporary classics such as Yoga Ratnākara (Anonymous, 2005) and  Bhāva Prakāśa (Dwivedi, 1998) focussed on herbo–mineral preparations which indicate the requirement of such potent medicines to combat sannipāta conditions during the period. All points considered, Jvaranirṇaya is a manuscript which has the potential to be explored in detail and translated. It could yield very important clues on treating subtle and complex sannipāta conditions which pose a great challenge to the clinicians.