Case-study: A Clinical Case-study On Ayurvedic Management of 'Jeerna Jwara' w.s.r. Recurrent UTI.

 

A Clinical Case-study On Ayurvedic Management of 'Jeerna Jwara' w.s.r. Recurrent UTI

Author: Dr. Vaibhavi Jani¹, Dr. Yogina Rathwa¹, Dr. Nihal Kanziya¹, Dr.  Anamika Soni²

1.    1. Second Year Resident Doctor, Post Graduate Department of Kayachikitsa, Government Akhandanand Ayurved College, Ahmedabad, Gujarat, India.

2.     2.Associate Professor, Post Graduate Department of Kayachikitsa, Government Akhandanand Ayurved College, Ahmedabad, Gujarat, India.

Abstract

Jwara  is the unique description of the disease that essentially affect the human being at various stages of the life with many causes and it needs specific measures accordingly. If the Vyadhikshamatva or Dhatusaushthava is appropriate then Jwara can be treated easily. Otherwise, it may act as vitiated doshas in dormant phase and there may be chances of recurrence of fever along with multisystem clinical presentation that is known as “Dhatugatatva Pattern” in Ayurveda. In Present Case Study, A 44-year-old female patient came to OPD no. 4, P.G.  Kayachikitsa Department, Government Akhandanand Ayurveda College and Hospital, Ahmedabad, Gujarat with the clinical presentation of Jwara, Shirashoola, Udarashoola, Yonitah sweta shrava, Udgara pravrutti and Mutradaha in the last 6 months. She was having H/O recurrent malaria and UTI (E.Coli infection). She was treated on the line of treatment of Jeerna Jwara, as instructed in Charak Samhita and got significant relief.

Keywords: Recurrent Malaria, Recurrent UTI (E.Coli infection), Jeerna Jwara

Introduction

Recurrent malaria refers to the reappearance of malaria symptoms after a period of being symptom-free following an initial infection. This recurrence can manifest in different ways, each with unique underlying causes and implications for treatment and control efforts.

Types of recurrent malaria

Relapse: Occurs primarily with Plasmodium vivax and Plasmodium ovale infections. Relapse happens due to the activation of dormant liver-stage parasites called hypnozoites. Even after successful treatment of the blood-stage infection, these hypnozoites can reactivate and release merozoites into the bloodstream, triggering a new episode of malaria

Recrudescence: Characterized by the reappearance of malaria parasites from the same parasite population that caused the initial infection. This occurs when a previous treatment failed to completely clear all parasites from the bloodstream, allowing the remaining parasites to multiply and cause a new symptomatic episode

Reinfection: Involves the acquisition of a new malaria infection through the bite of another infected mosquito. This means a completely new parasite strain enters the body, leading to a new malaria episode, even if the previous infection was successfully cleared.

Recurrent urinary tract infections (UTIs) are 2 or more episodes of acute bacterial cystitis, associated symptoms within the last 6 months, or at least 3 episodes within the previous year. Recurrent UTIs are more common in women.

Several conditions may predispose both men and women to have an increased risk of developing acute and recurrent UTIs, including: Anatomical defects that lead to stasis, obstruction, or urinary reflux, Atrophic vaginitis, Bladder diverticula, especially those that do not drain well, Cystoceles and pelvic organ prolapse in women, Functional defects (e.g. overactive bladder and urinary incontinence), Inadequate or incomplete treatment of the initial acute cystitis, Increasing bacterial resistance to antibiotics, Older men with outlet obstruction or neurogenic bladder, causing urinary stasis and incomplete bladder emptying, Sexually active women without any identifiable structural abnormality or another predisposing condition, Vesico-ureteric reflux (identified in up to 40% of children with a first UTI). Notably, immunodeficiency alone typically does not lead to isolated recurrent UTIs.

In Ayurveda, "Jeerna Jwara" refers to chronic or persistent fever, which is a fever that has lasted for more than a week or recurs frequently. It is considered a more complex condition than acute fever (Nava Jwara) due to the involvement of deeper tissues and imbalances in the body's systems.

 It is often associated with the vitiation of all three doshas (Vata, Pitta, and Kapha), though the specific dosha dominance can vary. Ayurveda emphasizes the role of Agni in maintaining health. In Jeerna Jwara, Agni may be weakened or imbalanced, leading to impaired digestion and assimilation of nutrients. The body's channels (Srotas) may also be affected, impacting the circulation of bodily fluids and nutrients.

Material and Methods

Patient’s information

A 44-year-old female patient presented to OPD no. 4 (PG Kayachikitsa Department) at Govt. Akhandanand Ayurveda College and Hospital, Ahmedabad, with the following symptoms…

Jwara (on and off fever) since 6 months

Shirashoola (Headache) since 6 months

Udarashoola (Pain in Abdomen) since 6 months

Yonitah sweta shrava (Luekorrhea) since 6 months

Udgara pravrutti (Belching) since 3 months

Mutradaha (Burning Micturition) since 3 months

Past History:  Recurrent Malaria and UTI (E. coli infection)

Family History:  NAD

Drug History: Antimalarial Drugs

General physical examination:

Built- Medium

Pulse- 72/min

Respiratory rate- 18/min

BP- 110/64 mmHg

Conjunctiva – Normal

Tongue- Normal

Skin – No oedema or icterus

Dashvidha Pariksha

Prakruti- Vata-Pitta

Vikruti-Mahat Hetu Linga Bala – Recurrent UTI and Malaria

Sara- Rasa-Rakta Madhyama Sara

Samhanan- Madhyam

Praman- Madhyama

Satmya- Shad rasa Satmya

Ahara Shakti- Madhyama

Vyayam Shakti- Alpa

Vaya- Yuva Avastha

Therapeutic intervention (IPD)

Date	Symptoms	Medicine	Duration	Anupan
06/08/24- 20/08/24	Jwara on and off Shirashoola ++ Udarashoola +++ Yonitah sweta shrava  Udgara pravrutti ++ Mutradaha +++	1) Avipattikar Churna 6gm + Mukta Sukti 500 mg + Dhatri Lauha 250 mg + Swarnmakshik. 250 mg	BD before food	1 tsp Goghrita
		2) Shankha Vati 2tab    Samshamani Vati 4tab	2 BDAfter food	Water
		3) Gokshuradi Guggulu 2    Chandrakala Rasa 2 tab Vasa tab 2 tab	TDS After food	Water
		4) Punarnavadi Kwatha	Empty Stomach BD
21/08/24- 03/09/24	Jwara nasti Shirashoola + Udarashoola ++ Yonitah sweta shrava  Udgara pravrutti + Mutradaha ++	1,2,3,4
04/09/24- 14/09/24	Shirashoola nasti Udarashoola + Yonitah sweta shrava  Udgara pravrutti + Mutradaha +	1,2,3,4

 

Date	Procedure
06/08/24- 22/08/24	1)Sthanika Abhyanga and  Nadi Swedana (Urah evam Prustha Pradeshe)	Nirgundi Taila
	2)Karma Basti (450 ml)	Niruha – Anuvasan-
23/08/24- 14/09/24	1)Sthanika Abhyanga and Nadi Swedana (Urah evam Prustha Pradeshe)
	2)Kshira Basti (200 ml)

OPD Follow Up

	Symptoms	Medicine	Duration/Time	Anupana
16/09/24- 23/09/24		1)Punarnavadi Kwatha 10 gm	Bd Empty stomach
		2)Mahakalyanak Ghruta 20 ml	Suryodaya Kala	Warm water
		3) Avipatikar Churna 5gm +Mukta Sukti 500 mg + Swarna Makshik125 mg + Dhatriloha 250 mg	BD  Empty stomach	Madhu
		4) )Shankha Vati 2tab     Samshamani Vati 4tab	BD After food	Go Ghrita
		5) Gokshuradi Guggulu 2 tab    Chandrakala Rasa 2 tab    Vasa tab 2 tab	BD After food
		6) Sudarshan Churna 5gm+ Vasa Churna 3gm	1 tds After Food

Results

REPORTS:

Before treatment report:

After treatment report

  

       

Patient's Testimonial Video-

(Updated on 09/03/2026)

Discussion

Patient had Malarial fever 6 months back and she was given Antimalarial drugs, but after completing the treatment occurrence of signs and symptoms started as Jwara, Shirashoola (Headache), Udarashoola (Pain in Abdomen), Yonitah sweta shrava (Luekorrhea), Udgara pravrutti (Belching), Mutradaha(Burning Micturition) which was the sign of impaired Vyadhikshamatva .

On Investigation Urine Culture shown E-COLI Bacteria positive and the USG W/A showed the changes of cystitis.

As per Principle,

इह खलु निदानदोषदूष्यविशेषेभ्यो विकारविघातभावाभावप्रतिविशेषा भवन्ति |

 All 3 Nidana, Dosha, Dushya combined together in the presence of compromised immunity and sign and symptoms occurred accordingly.

In this case scenario there was Leena doshas after improper treatment and consumption of contradictory diet (Apathya Ahara) due to which there was Shleshma kshaya which ultimately lead to Oja kshaya causing Prakopa of Vata-Pitta dosha. This further caused the leenatva of doshas and causing Punaravartaka Jwara leading to Dhatugatva involving Rasa-Rakta-Mamsa. Thus as per the condition of “Jeerna Jwara” with multisystemic presentation, we aimed the management by applying Classical line of treatment of Jeerna Jwara as per Charak Samhita viz,

·       Deepan

·       Pachana

·       Anuloman

·       Dhatuposhan

To install the strength along with various medication that helps to break the Pathogenesis.

Following Samprapti Ghatakas has been framed/ identified.

Samprapti Ghatak

Dosha- Pitta Pradhan Tridosha

Dushya- Rasa, Rakta, Mamsa, Meda

Strotas-  Rasavaha, Raktavaha, Medovaha, Mutravaha, Purishvaha

Stroto Dusti Prakar- Sanga, Vimargagaman

Adhisthan- Sarva sharir evam Mutravaha srotas

Udbhavsthan- Aamashaya

Vyaktisthan- Urah Pradesha/ Phupphusa

Roga Marga- Madhyama (Kostha)

Agni- Mandagni, Vishamagni

Sama/Niram- Sama

Vyadhi Prakar- Chirakari

Sadhyaasadhyata- Kruccha Sadhya

The patient was so exhausted and depressed, with her complains that in her first visit she agreed for IPD admission and management started as per her condition. Initially Dipan, Pachan, Vatanuloman, Started with combination of Avipatikar Churna etc. with Sahapana, Go ghrita in Apana Kala.

Shankha Vati was given after meal Uttara Bhakta for Dipana, Pachana.

Samshamani Vati was given as Vyadhi Pratyanika with the purpose to get relief in fever

Punarnavadi Kwatha and Gokshuradi Guggulu 2tab Chandrakala Rasa 2 tab and Vasa tab 2 tab after meal Uttara Bhakta  was given for burning micturition Mutravaha srotodushti.

Additionally, Sarvanga Abhyanga Swedana followed by Karma Basti was administered for Shodhan. After completion of Karma Basti-- Kshir Basti has been given in order to restore the strength and do the Dhatuposhan and provide the immunity to the body.

This treatment protocol was given for 30 days and patient was discharged on her request after achieving 90% relief in symptom.

In follow up treatment patient was adviced  Mahakalyanak Ghrita 20 ml in Rasayana Kala (Sunrise time) for 5 days.

And combination of  Sudarshan churna and Vasa churna was added

Conclusion

It can be concluded that in absence of the appropriate immunity simple UTI cannot be treated with Antibiotic and Antipyretic etc. drugs. These remaining Leena doshaas silently deteriorate the Body Tissues also. So Ayurvedic management with classical Jwara Chikitsa have significant results in such patients by breaking the vicious cycle of Samprapti (Pathogenesis).

 

 

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Above article has been published in 'Ultimate Research Journal of Ayurveda.'

(A Govt. Akhandanand Ayurveda College, Ahmedabad, Gujarat Publication.)

Full Article link:

https://urja.gaac.co.in/index.php/urja/article/view/24

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