The Compendium of Caraka 2.1: prathamo 'adhyāyaḥ/

Now we shall expound the etiology of fever.

Thus spoke the venerable Ātreya.

Here, indeed, hetu, nimitta, āyatana, kartṛ, kāraṇa, pratyaya, samutthāna, and nidāna are synonymous.

It is threefold: unwholesome contact with sense objects, error in judgment, and transformation.

From these, three kinds of diseases arise: fiery, watery, and airy; and others are twofold: rajasic and tamasic.

There, vyādhi, āmaya, gada, ātaṅka, yakṣman, jvara, vikāra, and roga are synonymous.

Its apprehension is by means of etiology, premonitory symptoms, symptoms, therapeutic suitability, and pathogenesis.

There, etiology (nidāna) has been stated previously as ‘cause’.

Premonitory symptom (pūrvarūpa) is the sign of a disease prior to its arising.

Symptom (liṅga), on the other hand, is the manifested sign. There, liṅga, ākṛti, lakṣaṇa, cihna, saṃsthāna, vyañjana, and rūpa are synonymous.

Therapeutic suitability (upaśaya), moreover, is the application of medicines, diet, and conduct that are contrary to the cause or disease, or that produce an effect contrary to them, resulting in relief.

Pathogenesis (saṃprāpti), jāti, and āgati are synonymous with respect to disease.

It is differentiated by distinctions of number, dominance, variety, fractional distribution, strength, and time.

Number, to begin with, is such as: eight fevers, five abdominal swellings, seven dermatoses, and so forth.

Dominance, moreover, is discerned through the degrees and superlative degrees of the doṣas.

Between two [doṣas], there is the comparative degree (-tara); among three, the superlative (-tama).

Variety (vidhi) is twofold by the division into innate and exogenous; threefold by the division into the three doṣas; and fourfold by the division into curable, incurable, mild, and severe.

Fractional distribution (vikalpa), moreover, in this context means the breakdown according to the fractional strength of each combined doṣa.

The distinction of strength and time (balakālaviśeṣa) of diseases, furthermore, is determined by the specific rules governing seasons, day and night, and meal times.

Therefore, a physician whose mind and intellect are unimpaired should properly understand diseases through factors such as etiology and the rest.

Thus the concise summary of the subject matter of the Nidānasthāna has been set forth.

Teaching it in detail, we shall explain it further from this point onward.

There, first of all, we shall explain the first eight diseases arising from greed, malice, and anger in regular order beginning with their etiology, as well as a mere aphoristic summary of their therapeutics.

And in the [section on] therapeutics, we shall subsequently explain the accumulated disorders in detail.

Here indeed, fever is taught first among disorders, because it is the foremost among somatic diseases.

Now indeed, fever arises in human beings from eight causes; that is to say: from vāta, from pitta, from kapha, from vāta and pitta, from vāta and kapha, from pitta and kapha, from vāta, pitta, and kapha, and from an exogenous [factor] as the eighth cause.

We shall explain its distinctive etiologies, premonitory symptoms, signs, and therapeutic suitabilities.

Vāyu becomes aggravated by excessive indulgence in dry, light, and cold [foods and regimens]; excessive application of emesis, purgation, non-unctuous enema, and errhines; exercise; suppression of natural urges; fasting; trauma; sexual intercourse; anxiety; grief; excessive bloodletting; staying awake at night; and awkward bodily postures.

When aggravated, it enters the stomach, mixes with the bodily heat, reaches the primary tissue resulting from the digestion of food called chyle (rasa), blocks the channels carrying chyle and sweat, impairs the digestive fire, expels the heat outward from the seat of digestion, and spreads through the entire body; then it produces fever.

Its signs are as follows: irregular onset and relief; irregularity of temperature; instability of fever between mild and intense states; arrival or increase of fever at the end of digestion, at the end of day, at the end of night, or at the end of summer; especially a rough, reddish-brown discoloration and excessive emaciation of nails, eyes, face, urine, feces, and skin; various types of shifting pains in various body parts, such as: numbness in the feet, cramps in the calves, a sense of dislocation in the knees and in all joints, fatigue in the thighs, and a feeling as if broken, aching, crushed, churned, cracked, torn, and compressed in the waist, flanks, back, shoulders, arms, scapulae, and chest; stiffness of the jaws; ringing in the ears; piercing pain in the temples; astringent taste in the mouth or tastelessness; dryness of the mouth, palate, and throat; thirst; tightness in the chest; dry vomiting; dry cough; suppression of sneezing and belching; aversion to the taste of food; excessive salivation, anorexia, and indigestion; dejection, yawning, bending of the body, trembling, exhaustion, giddiness, delirium, sleeplessness, horripilation, and teeth-chattering; desire for warmth; unsuitability of things mentioned in the etiology and suitability of their opposites—these are the signs of vāta fever.

Pitta becomes aggravated by excessive indulgence in hot, sour, salty, alkaline, pungent foods, and eating before the previous meal is digested; as well as from intense exposure to the sun and fire, exertion, anger, and irregular diet.

When aggravated, it approaches the heat of the stomach, reaches the primary tissue resulting from the digestion of food called chyle, blocks the channels carrying chyle and sweat, impairs the digestive fire due to its liquidity, expels the heat outward from the seat of digestion, and, causing distress, spreads through the entire body; then it produces fever.

Its signs are as follows: simultaneous arrival or increase of fever throughout the entire body, especially at the time of digestive combustion, at midday, at midnight, or in autumn; pungent taste in the mouth; inflammation of the nose, mouth, throat, lips, and palate; thirst; intoxication; giddiness; fainting; vomiting of bile; diarrhea; aversion to food; prostration; exhaustion; delirium; appearance of red circular eruptions on the body; greenish-yellow discoloration of nails, eyes, face, urine, feces, and skin; excessive intensity of temperature; extreme burning sensation; desire for coldness; unsuitability of things mentioned in the etiology and suitability of their opposites—these are the signs of pitta fever.

Śleṣman becomes aggravated by excessive indulgence in unctuous, heavy, sweet, slimy, cold, sour, and salty [foods]; daytime sleep; rejoicing; and lack of physical exercise.

When aggravated, it enters the stomach, mixes with the bodily heat, reaches the primary tissue resulting from the digestion of food called chyle, blocks the channels carrying chyle and sweat, impairs the digestive fire, expels the heat outward from the seat of digestion, and, causing distress, spreads through the entire body; then it produces fever.

Its signs are as follows: simultaneous arrival or increase of fever throughout the entire body, especially immediately after eating, in the forenoon, in the early part of the night, or in spring; heaviness of the body; lack of desire for food; excessive salivation of phlegm; sweetness in the mouth; nausea; sensation of coating in the heart region; feeling of being wrapped in a wet cloth; vomiting; sluggishness of the digestive fire; excessive sleep; stiffness; drowsiness; cough; dyspnea; catarrh; coldness, and whiteness of nails, eyes, face, urine, feces, and skin; and cold eruptions arising profusely on the limbs; desire for warmth; unsuitability of things mentioned in the etiology and suitability of their opposites; thus are the signs of śleṣman fever.

Due to irregular eating, fasting, change of diet, vitiation of the seasons, smelling unsuitable odors, consuming poisoned water, slow poisons, proximity to mountains, improper administration of unction, fomentation, emesis, purgation, non-unctuous enema, unctuous enema, and head evacuation, or faulty post-therapeutic regimens, and in women due to abnormal childbirth and improper care after delivery, as well as due to a combination of the aforementioned causes, either any one pair of doshas or all three doshas simultaneously become aggravated according to their etiologies; being aggravated, they produce fever following that very same sequence.

There, one should recognize either a dual-dosha fever or a fever born of all three doshas (sānnipātika) by observing the specific combination of the symptoms of fever described in that manner.

Fever arising from external causes (āgantu) is indeed the eighth, preceded by pain, originating from trauma, possession or emotional affliction, sorcery, and curses.

Existing for some time purely as an external affliction, it is later joined by the doshas.

Among these, that born of trauma is accompanied by vāta residing in vitiated blood; that born of possession or emotional affliction by vāta and pitta; but those born of sorcery and curses are accompanied by all three doshas together.

It should be understood as distinct from the seven varieties of fever because of its distinct signs, therapeutic management, and onset; and it is treated with common therapy.

Thus the eightfold nature of fever has been declared.

Fever, however, is singular in having burning heat (saṃtāpa) as its characteristic.

Physicians declare it to be of two kinds according to specific intention, and by virtue of the distinction between innate (nija) and external (āgantu).

There, physicians declare the innate to be of two kinds, three kinds, four kinds, and seven kinds, according to the fractional distribution of vāta and the others.

Its premonitory symptoms are as follows: bad taste in the mouth, heaviness of the body, lack of desire for food, blurred eyes, watering of the eyes, excessive sleep, restlessness, yawning, stooping, trembling, fatigue, giddiness, delirium, sleeplessness, horripilation, tingling teeth, alternating tolerance and intolerance of sound, cold, wind, and sunshine, anorexia, indigestion, weakness, body aches, malaise, shortness of breath, procrastination, laziness, decline in regular duties, aversion to one's own tasks, indignation at the words of elders, dislike for children, unconcern for one's duties, discomfort from garlands, unguents, and food, aversion to sweet edibles, and fondness for sour, salty, and pungent things—these are the premonitory symptoms of fever before burning heat occurs; and they continue to accompany the sufferer even when afflicted by burning heat.

In this way, these symptoms of fever have been explained one by one, in detail and in brief.

Fever, indeed, originated from the anger of Maheśvara; it takes the life of all living beings, causes burning torment to the body, sense organs, and mind, diminishes intelligence, strength, complexion, joy, and enthusiasm, and produces fatigue, exhaustion, confusion, and obstruction to food intake. It is called jvara because it torments (jvarayati) the body; no other diseases are so dreadful, so full of complications, and so difficult to cure as this one.

It is the overlord of all diseases, and it is designated by diverse names among various animal species.

All living beings are born with fever and die with fever; it is the great delusion, overcome by which embodied beings do not remember any deed of their previous life, and in the end it is fever alone that takes away the lives of all living beings.

There, upon seeing the premonitory symptoms or at the onset of fever, a light diet or reducing therapy (apatarpaṇa) is beneficial, because fever originates in the stomach; thereafter, decoction drinks, massage, unction, fomentation, poultices, affusion, unguents, emesis, purgation, non-unctuous enema, unctuous enema, pacification therapy, errhine therapy, fumigation, medicated smoking, collyrium, and regimen of milk and food should be administered appropriately according to reason.

In all chronic fevers, however, the drinking of clarified butter prepared with appropriate drugs is praised; for clarified butter pacifies vāta due to unctuousness, kapha due to processing, and pitta and bodily heat due to coolness; therefore, in all chronic fevers, clarified butter is beneficial like water on things scorched by fire.

And here are [the verses]:

Just as people sprinkle a blazing house with water / desiring it to be extinguished, so is ghee in chronic fever.

Due to unctuousness it pacifies vāta, due to coolness it restrains pitta; / though having qualities similar to the dosha, ghee overcomes kapha by processing.

No other unctuous substance adapts to processing in such a manner / as clarified butter; hence clarified butter is considered the best of all unctuous substances.

A subject stated in prose that is subsequently sung in verses / to clarify its meaning is not censured as redundant.

Here are the verses:

The three kinds of synonyms for etiology, the fivefold disease, / the synonyms for disease symptoms, the fivefold comprehension of disease,

The eightfold fever, its remote and immediate causes, / its premonitory symptoms, symptoms, and treatment in brief—

All this the venerable Punarvasu, free from fever [and grief], expounded / in the section on etiology regarding fever,

To the bowed Agniveśa.

Thus, in the section on etiology of the compendium composed by Agniveśa and redacted by Caraka, ends the first chapter, entitled "Etiology of Fever." //1