A case of fever which involves, and is due to the combined action of any two deranged Doshas of the body, is called Dwaudvaja fever and such cases are classified into three different types (e.g. Vata-pitta-fever, Vata-s'leshma-fever and Pitta-s'leshma-fever). Yawning, distension of the abdomen, loss of consciousness, shivering pain in the joints, emaciation of the body, thirst, delirium and heat or increased temperature of the skin, are the characteristic symptoms of Vata-pitta fever (due to the action of the deranged Pitta and Vayu). Aching-pain (Sula), cough, the vomiting of Kapha, shivering, coryza, cold, sense of heaviness of the limbs, aversion to food, and a feeling of general numbness, are the
* The fever in which Vayu predominates gets aggravated on the 7th, that in which Pitta predominates becomes aggravated on the 10th and that in which Kapha predominates comes to be aggravated on the 12th day. According to some authority, however, Abhinyasa, Hataujasa, and Sannydsa types of fever are pacified on the 7th, 10th and 12th. day respectively. - Dallaua, symptoms of a case of Vata-sleslima-fever (due to the action of the deranged Vayu and Kapha). Sensation of cold and heat, aversion to food, numbness, perspiration, epileptic fits, unconsciousness, vertigo, cough, lassitude and nausea are the symptoms which characterise a case of Pitta-sleshma.-fever (due to the action of the deranged Pitta and Kapha) * . 19 - 21.
Even a small residue of the deranged bodily Doshas in a patient just cured of an attack of fever but still sufferring from weakness and indulging in injudicious regimen of diet and rule of conduct, is apt to be augmented and aggravated by the deranged Vayu of the body, and thus begets five different types of fever lodged in any of the five specific locations of Kapha †. These five types are known as the Satata, Anyedyushka, Tritiyaka, Chaturthaka and the Pralepaka ‡. The (residue of the) deranged Dosha of the body, shifting from one location of Kapha to the next in the course of the entire day
* Dallana in his commentary has quoted in eight lines with different wordings the symptoms of these kinds of Dw indvaja fever and these lines have been adopted by Midhava in his Nidana The lines when transtated would be thus : - Thirst, unconsciousness, vertigo, burning sensation, somnolence, pain in the head, dryness of the mouth and of the throat, vomiting, horripilation, disrelish for food, giddiness, pain in the joints, and yawning are the symptoms of Vata-pitta-fever. Sensation of moisture all over the body, pain in the joints, excessive sleep, heaviness of the limbs, pain in the head, catarrh, cough, scanty perspiration, slight sensation of heat, and pulsation not too quick nor loo slow, are the symptoms of Vata-s'leshma-fever. A bitter taste, a coating on the mouth, somnolence, unconsciousness, cough, disrelish for food, thirst, alternate and varying sensation of heat and cold are the symptoms of Sleshma-pitta-fever and night, ultimately finds lodgment in the Amas'aya (stomach) and thus brings on the virulent attack of (those) fevers. Of these the type known as the Prale-paka appears in cases of Sosha (consumption) and though its attak is a mild one, it puts almost insurmountable difficulties in the way of its cure, brings about a loss or waste of Dhatus (the seven fundamental principles of the organism) and thus ultimately ends in death. There are cases of Vishama-jwara known as the Viparyyaya type (reverse of the above type) which arc the result of the deranged bodily Doshas being simultaneously located in two or four specific seats of the deranged bodily Kapha and are hard to cure. 22 - 23.
† The five locations of Kapha are the Amas'aya, chest, throat, heal and the joints.
‡ There is another kind of Vishama Jwara named Sanlala (of. S'loka 31 of this Chapter) and Dallana remarks that it is begotten wh-n the residue of the deranged Dosha is lodged in all the five seats of Kapha.
Several authorities hold Vishama Jvara to be sui-generis in its origin. But whether spontaneously idiopathic or not, an extraneous fact (either a passing psychic condition such as fear, grief, etc. or the presence of any foreign poisonous matter in the system) is always involved in and intimately connected with a case of Vishama fever. The pre-dominance of the deranged and aggravated Vayu is marked in cases of Tritiyaka (tertian) and Chaturthaka (quartan coming on every fourth day) fevers. A case of fever due to the abuse of any wine or ardent spirits as well as the one occuring in a low land at the foot of a mountain, should be supposed to involve a predominant action of the deranged and aggravated Pitta. A case of Pralepaki fever is due to the concerted action of the deranged and aggravated Vayu and Kapha, of which the action of the latter should be regarded as more dominant. Cases of Vishama fever ushered in by epileptic fits should be regarded as the result of the concerted action of any two deranged Doshas of the body. 24 - 25.
The deranged Kapha and Vayu of the body, if located under the surface of the skin, produce cold (shivering) during the first istage of fever, while the deranged Pitta brings on the characterstic burning sensation at its latter stage after the subsidence of the deranged Kapha and Yavu. In certain cases the burning sensation is engendered by the deranged Pitta at the outset, cold (shivering) being brought on by the deranged Kapha and Vayu at the latter stage after the subsidence of the deranged Pitta. Both these two types of fever are brought on through the combined action of two deranged Doshas of the body and of these two, the type which is ushered in by a burning sensation in the body is extremely hard to cure. A case of continued fever resulting from an abnormal psychic condition (such as anger, grief, desire, etc.) or due to any blow or hurt is likewise hard to cure. 26 - 28.
Fever of the Vishama type attacks a man in various ways and follows a distinct periodicity, it being aggravated during the six specific times of dominance of the deranged bodily principles (Doshas) as mentioned before * in the course of day and night. This Vishama fever never finds complete remission, (but lurks in the deeper organic principles of the body) and produces a sense of physical langour and heaviness of the limbs as well as the characteristic emaciation. It is called Vishama-jwara because its abatement is always confounded with its cure and remission, and this confounding is due to the fact that the disease (fever) lies dormant in a very small degree in the deeper principles of the vital organism to be patent only at the slightest exciting cause, just as a feeble fire fed with an insufficient supply of fuel, becomes patent at the slightest exciting cause. 29.
* See chapter XXI (Medical Treatment Of The Diseases Peculiar To The Car (Karna-Gata Roga-Pratishedha)). - Sutra-sthana.