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
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)
|
|
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,
เคเคน เคเคฒु เคจिเคฆाเคจเคฆोเคทเคฆूเคท्เคฏเคตिเคถेเคทेเคญ्เคฏो เคตिเคाเคฐเคตिเคाเคคเคญाเคตाเคญाเคตเคช्เคฐเคคिเคตिเคถेเคทा เคญเคตเคจ्เคคि |
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).
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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