Jeerna Jwara

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Table of Contents
Casestudies of Contents

Brief Medical History

Presenting Complaints with severity and episode duration

1. Recurrent onset of fever/ rise in body temperature since 2 years
2. Easy fatigability, Angamarda (Myalgia) since 2 years
3. Kshavathu, Kasa with thick white Kapha Sthivana since 2 years

All these complaints are more during evening hours. On and off nature of the presenting complaints every 3 to 4 days, has made the patient consult.

Poorva Vyadhi Vrittanta :
H/O being undergoing septoplasty for Deviated Nasal Septum

Treatment History:
Patient had taken allopathic medications for the same for a period of one week before one month. Patient has stopped as he did not observed considerable improvement.

Allergies: Dust and Pollen

Integrated Summary

Clinical Status
Allopathy Ayurveda
Vital Parameters
BP – 130/80 mm Hg
Pulse – 78/min
Weight -75.8kgs
BMI – 27.86
WHR - >0.9
Temp – 1000F
Asta Sthana Pariksha
Nadi - P3 V3K1
Malam - 2 to 3 times/day, Incomplete completion/ Asamhata varchas
Mutra - 4 to 6/0 times/D/N
Jihva - Alpa liptata
Shabda - Prakrutha
Sparsha - Prakrutha
Drik - Prakrutha
Akruti - Sthoola
Examinations
GC – fair
CVS
CNS
PA
RS – URT: Bilateral
Hypertrophied nasal turbinates.
Congested Hyperaemic posterior pharyngeal wall.
LRT: Lung fields: clear
No crepitus/ronchi.
NVBS heard.
Dasa Vidha Pariksha
Prakriti - Kapha Pitta
Vikriti – Pitta Vata
Sara – Madhyama
Samhanana - Madhyama
Pramana - Pravara
Satmya - Madhyama
Satva - Madhyama
Aharashakti – Manda agni
Vyayam Shakti - Madhyama
Vaya - Madhyama
Desha - Sadharana
Kala – Sharad

Rogi Bala - Madhyama

Roga Bala - Madhyama

DSQ findings Rating
1. ADRS
low
2. ADSS
Med
NidanaPanchaka
Nidana -Srama, Alpagni
Purvaroopa - Angamarda, Klama
Roopa -Jwara, Kshawatu, Kasa, Kapha stewana- more during Vata Pitta Kala i.e 5 to 8 pm
Updrava: NIL
Arishta Lakshana: NIL
Samprapti:
Dosha: Vata Pitta
Dushya: Rasa , Rakta
Agni—Jataragnimandya
Ama - Tatjanya
Srotas - Rasavaha, Rakta vaha
Sroto Dushti Prakara - Sanga, Vimarga gamana
Differential Diagnosis with reasoning

1. Pulmonary TB: Classical prevention is fever, haemoptysis, cough, weight loss and night sweats. Positive CXR and sputum for AFB
2. HIV related Presents with fever, weight loss, sweats, lymphadenopathy or with opportunistic infection Hx recurrent infection and oral thrush History of Sexual contacts, Birthplace, Exposure events, occupation O/E Full exam-enlarged Lymph nodes and spleen Ix: HIV antibody test and HIV viral load, CD4 count
3. Autoimmune disorders History of joint pain, rash, and photosensitivity
4. Malignancy: Leukaemia/Lymphoma History of fever, sweats, weight loss, fatigue O/E- Lymph nodes enlarged, Hepatosplenomegaly Investigations: Bone Marrow aspirate, blood smear, Complete Blood Count
5. Infectious mononucleosis Diagnosis Mononucleosis is characterized by fever, sore throat, fatigue, malaise, and loss of appetite. Sore throat is the first indication of sickness and in some it is the only major symptom throughout the entire illness Patients generally have swelling of the lymph nodes in the neck and often have an enlarged spleen is not present in this case.
Differential Diagnosis with reasoning

Jeerna jwara
Visama jwara
Punaravartaka jwara
Nirama jwara
Lab Tests:
13/07/2014
HBsAg – Negative
Anti HCV—Negative
TSH – 3.51U/IU/ml
EBV IgG – POSITIVE
EBV IgM- NEGATIVE.
FBS-95 mg/dl
Total bilirubin- 0.37 mg/dl.
Direct bilirubin-0.05 mg/dl
Indirect bilirubin-0.32 mg/dl
Total protein-7.6 gm/dl.
Albumin-4.4 gm/dl
Globulin-3.2gm/dl
AG ration-1.4
SGOT-24 U/LT
SGPT-39U/LT
GGT-54U/LT.
AKP-80U/LT.
Evidence Based Diagnosis:

Infectious Mononucleosis
Presence of changes in EBV
IgG – POSITIVE
EBV IgM - NEGATIVE suggest
the disease is Infective mononucleosis
Evidence Based Diagnosis: Jeerna Jwara
Chikitsa:

Chikitsa Vivechana:
Agnideepana
Strotovishodhana
Ojovardhaka
Medication given:
1. Guduchi Ghana Vati—2-0-2( BEFORE FOOD)
2. Chyavanaprasha Avaleha - 1 tsp at bed time.
3. Bhadradarvyadi Kashayam—10ml twice daily with half cup of warm water before food.
4. Vaishwanara Choorna 15gms + Kamadudha Rasa 2.5gms + Shringa Bhasma 5gms + Karpooradi Choorna 15gms—¼ tsp with honey three times a day before food
5. Gorochanadi Vati1-1-1
6. Anu Taila Pratimarsha- 4 drops to each nostril in the early morning
7. Dashamoola Katutrayadi Kashayam- 10ml twice daily with ½ cup of warm water.

Integrated View: Infectious Mononucleosis can be understood and managed as Jeerna Jwara in Ayurveda. As the Dosas get Leena (get deep seated), the Jwara disappears for the time. So there is a chance of relapse. Hence, Agni has to be constantly monitored and maintained with medications.

Outcome

# Outcome Parameters / / Date-Time N
19/11/14
1st review
29/11/2014
2nd Review
9/12/2014
Last Review
24/1/2015
1.

Sleep (Nidra)

Samyak

Samyak

Samyak

Samyak

2.

Appetite (Agni)

Manda

Able to digest light food

Timely hunger

Sama

3.

Bowels (Mala)

Samhata

Samhata

Samhata

Samhata

4.

Urination (Mutra)

Samyak

Samyak

Samyak

Samyak

5.

Ability to cope Stress (Manas)

2/5

3/5

3/5

4/5

6.

BP mm of Hg

130/80

120/80

120/80

110/80

7.

Pulse

78/min

74/min

76/min

72/min

8.

Weight, Kg

75.8

75.8

76

76

9.

Diet (Ahara)

Fair

Fair

Fair

Fair

10.

Exercise (Vyayama)

Walking

Walking

Walking

Walking

11.

Lifestyle (Vihara)

Fair

Fair

Fair

Fair

Conclusion

Ayurveda has been able to manage effectively the condition of Infectious Mononucleosis – Jeerna Jwara by addressing the root cause – Agni and Srotas with classical medications. This is evident by the fact that the patient is not having a relapse of fever in last 4 months.

* Outcomes may vary from person to person

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