The Comprehensive Ayurvedic Management of Jwara (Fever): An Evidence Based Narrative Review

The Comprehensive Ayurvedic Management of Jwara (Fever): An Evidence Based Narrative Review

Dr. Jajbir Singh

Department Of Swasthavritta & Yoga lal Bahadur Shastri Mahila Ayurvedic College & Hospital Bilaspur District Yamuna Nagar State Haryana

DOI: https://doi.org/10.51244/IJRSI.2025.12060064

Received: 07 June 2025; Accepted: 17 June 2025; Published: 07 July 2025

ABSTRACT

Jwara, broadly corresponding to fever in biomedicine, is one of the most elaborately discussed disease complexes in Ayurveda, encompassing infectious, inflammatory, and psychosomatic etiologies. Classical management relies on a staged approach beginning with langhana (fasting/lightening), followed by pachana–dīpana (carminative–digestive stimulation), and where necessary, śodhana (purification) and śamana (palliation), complemented by diet, lifestyle regulation, and rasāyana (rejuvenation). This narrative review synthesises classical tenets with contemporary clinical evidence from 2015 to April 2025, appraising randomised controlled trials, case reports, and in-vitro studies. Data show that formulations like Mukka-mukkatukādi, Kiratatikta, and Zingi Vir-H have statistically significant antipyretic effects and demonstrate favorable safety profiles. Limitations include small sample sizes, heterogeneous designs, and insufficient blinding. Robust multicentric trials are recommended.

Keywords: Jwara, Antipyretic, Langhana, Rasāyana, Integrative Medicine

INTRODUCTION

Fever remains one of the commonest clinical presentations worldwide. Ayurveda conceptualises fever as Jwara, a systemic perturbation of doṣa homeostasis primarily dominated by pitta but often involving vāta and kapha in varied permutations. Unlike the reductionist view of temperature elevation alone, Ayurvedic nosology extends to pathogenesis (samprāpti) stages, tissue involvement and the host’s digestive-metabolic fire (agni). This holistic framing offers opportunities for multimodal, low-cost interventions that may complement modern antipyretics and antivirals.

LITERATURE REVIEW

Fever, or Jwara, has been one of the most elaborately discussed pathological conditions in classical Ayurvedic texts. It is described not merely as an elevated body temperature but as a systemic manifestation affecting both physical and mental domains. According to the Caraka Saṃhitā and Aṣṭāṅga Hṛdaya, Jwara is considered the first and most critical disease, capable of afflicting all bodily tissues (dhatus), sense organs, and mental faculties (manas) (Sharma, 2013).

The Ayurvedic classification of Jwara is broad, encompassing exogenous (āgantuka) and endogenous (nija) causes, as well as acute and chronic variants. Each type is treated based on the dominance of doṣas—vāta, pitta, and kapha—and their pathological combination (sannipāta). The therapeutic approach emphasizes langhana (lightening therapy), pachana (digestive therapy), śodhana (purificatory therapy), and śamana (pacifying therapy) as the core interventions (Tewari, 2008).

Numerous classical formulations have been advocated for Jwara management. For instance, Sudarsana Churna, Amṛtottara Kashaya, and Gudūcī Sattva are traditionally prescribed for their antipyretic, digestive, and immune-enhancing effects. These preparations often contain potent herbs such as Tinospora cordifolia, Andrographis paniculata, Swertia chirata, and Zingiber officinale, which have demonstrated pharmacological properties including antipyretic, anti-inflammatory, immunomodulatory, and hepatoprotective actions in various preclinical and clinical studies (Puri, 2016; Sharma et al., 2021).

Contemporary studies have begun to validate these traditional interventions through scientific methodologies. A clinical trial by Kiran et al. (2022) found that a combination of Mukka-mukkatukādi syrup and Kiratatikta produced significant temperature reduction in febrile children, with no observed adverse effects. Similarly, a study on the polyherbal formulation ZingiVir-H demonstrated notable reductions in fever duration and inflammatory biomarkers like C-reactive protein (CRP) (Sharma et al., 2023). Such evidence reinforces the therapeutic potential of Ayurvedic medicines in managing febrile conditions without the risks commonly associated with conventional antipyretics such as NSAIDs.

Furthermore, in the context of viral fevers and emerging infections like COVID-19, Ayurvedic interventions have gained renewed attention. A case study by Joshi (2024) described successful management of Sannipātaja Jwara using Gudūcī and Sudarsana tablets, resulting in symptomatic relief and normalization of inflammatory parameters within 72 hours. This aligns with earlier textual guidance which highlights the role of tikta (bitter) and kaṭu (pungent) rasa in eliminating āmā (toxins) and restoring agni (digestive fire).

Several in vitro and in silico studies have explored the molecular basis of the antipyretic action of Ayurvedic herbs. For instance, Tinospora cordifolia has been shown to modulate IL-6 and TNF-α, critical mediators in the febrile response (Nair et al., 2020). These findings provide a pharmacodynamic rationale for the observed clinical efficacy of these botanicals in managing fever.

However, the literature also points to certain limitations. Most available studies are limited by small sample sizes, short duration, lack of blinding, and methodological heterogeneity. There is a paucity of large-scale randomized controlled trials (RCTs) that adhere to CONSORT and AYUSH-CARE guidelines, which are essential for establishing the efficacy and safety of Ayurvedic interventions in the management of Jwara (Patwardhan et al., 2015).

In summary, the available literature both classical and contemporary supports the efficacy of Ayurvedic interventions in the management of Jwara. The traditional understanding of fever as a systemic imbalance rather than a mere symptom offers a multidimensional framework for diagnosis and treatment. Continued clinical validation and translational research are required to substantiate and integrate these insights into modern clinical practice.

METHODS

A structured electronic search (PubMed, Scopus, AYUSH Research Portal, Google Scholar) was undertaken for English-language articles between January 2015 and April 2025 using the terms “Jwara”, “Ayurvedic fever”, “antipyretic Ayurveda”, “herbal antipyretic trial”. Inclusion criteria comprised clinical trials, observational studies, case reports and pharmacological evaluations of Ayurvedic interventions explicitly targeting fever. Eleven full-text studies and three narrative reviews met the criteria. Classical textual data were extracted from the Caraka Saṃhitā and Aṣṭāṅga Hṛdaya primary sources.

Ayurvedic Etiopathogenesis of Jwara

Etiology

Key provocative include seasonal irregularities, incompatible diet, emotional stress (śoka, bhaya) and microbial ingress according to contemporary understanding.

Pathogenesis

Initial doṣa aggravation obstructs rasa (plasma–lymph) circulation, impairing agni and producing pyrogenic metabolites that elevate body temperature. Staging:

Sañcaya (accumulation) – prodrome

Prakopa (aggravation) – chills

Prasara (spread) – fever spike

Vyakti (manifestation) – systemic symptoms

Bheda (complication) – chronicity or tissue invasion

Classification

Nava (acute), Santata (continuous), Satata (intermittent), Abhinnāmantha (remittent) etc.

Doṣaja sub-types: Vātaja, Pittaja, Kaphaja, Sannipātaja.

Diagnosis Criteria of Jwara (Fever) in Ayurveda

In Ayurvedic medicine, the diagnosis of Jwara (fever) is rooted in a comprehensive assessment of the individual’s constitution (prakṛti), the pathological state (vikṛti), doshic involvement, and clinical presentation. Unlike modern medicine, where fever is primarily identified by a rise in body temperature, Ayurveda views Jwara as a systemic disorder affecting śarīra (body), manas (mind), and indriyas (senses). The classical texts—including Caraka Saṁhitā, Suśruta Saṁhitā, and Aṣṭāṅga Hṛdaya—describe specific criteria for the diagnosis and classification of Jwara.

Cardinal Symptoms (Lakṣaṇas)

According to Caraka Saṁhitā, the following are considered the primary diagnostic symptoms of Jwara:

Jāḍya (Heaviness or Lethargy)

Āruchi (Anorexia or Loss of Appetite)

Angamarda (Body ache or malaise)

Shītalatā (Chilliness or feeling cold)

Daurbalya (Weakness or fatigue)

Stambha (Stiffness in body)

Uṣṇatā (Elevated body temperature)

Mūrcchā (Occasional fainting or loss of consciousness in severe types)

These symptoms manifest depending on the doṣa involved and the stage of fever.

Doṣic Involvement (Vāta, Pitta, Kapha)

Each doṣa produces characteristic signs and symptoms, guiding both diagnosis and treatment:

Type	Key Symptoms
Vātaja Jwara	Tremors, dryness of mouth, anxiety, restlessness, low-grade fever
Pittaja Jwara	High-grade fever, thirst, burning sensation, bitter taste, anger
Kaphaja Jwara	Heaviness, nausea, cough, chills, mucous discharge, dull pain
Sannipātaja Jwara	Mixed symptoms of all doṣas, usually more complicated and severe

Temporal Staging (Kāla Bheda)

The diagnostic process also involves determining the stage of Jwara:

Āma Avaṣṭhā (Toxic Stage): Presence of āmā (undigested metabolic toxins); characterized by heaviness, coated tongue, indigestion, and foul smell.

Nirāmā Avaṣṭhā (Post-Detox Stage): Fever without āmā; improved appetite, clearer tongue, and lighter symptoms.

Upaśama Avaṣṭhā (Remission Stage): Subdued symptoms, gradual return of appetite and strength.

Nidāna (Etiological Factors)

Identifying causative factors is critical in Ayurvedic diagnosis. Common causes include:

Consumption of incompatible or heavy food

Suppression of natural urges (vegadhāraṇa)

Excessive exposure to sun or cold

Emotional stress and anxiety

Exposure to infections (āgantuka hetu)

Rogamārga (Pathway of Disease)

Understanding the path of disease progression helps differentiate Jwara from other conditions:

Antaroga Mārga (Internal Path): Affects rasadhātu, rakta, and deeper tissues; seen in chronic fevers.

Bāhya Mārga (External Path): Often limited to superficial doshic imbalances and early-stage fevers.

Dashavidha Parīkṣā (Tenfold Diagnostic Parameters)

Ayurvedic diagnosis is also refined using ten-fold clinical examination:

Prakṛti – Body constitution

Vikṛti – Current imbalanced state

Sara – Tissue essence

Samhanana – Body compactness

Pramāṇa – Anthropometry

Satmya – Habitual diet/acclimatization

Sattva – Mental strength

Āhāra Śakti – Digestive capacity

Vyāyāma Śakti – Exercise capacity

Vaya – Age

This holistic evaluation ensures a personalized diagnosis beyond symptomatic temperature rise.

Modern Correlation

Although Ayurveda provides a unique diagnostic framework, certain aspects can be correlated with modern criteria such as:

Body temperature > 98.6°F (oral)

Elevated pulse rate, respiratory rate

CBC showing raised WBCs or neutrophils in infections

CRP or ESR elevation in inflammatory conditions

Yet, the Ayurvedic diagnosis focuses more on agni (digestive fire), āmā, and doṣic imbalance, offering a broader lens on systemic disharmony rather than localized pathology.

Principles of Ayurvedic Management

Therapeutic Stage	Key Interventions	Rationale
Langhana (lightening)	Warm water sipping, yavāgu (thin gruel)	Reduces toxic load, supports agni
Pachana–Dīpana	Śuṇṭhī, Pippalī, Maricha decoctions; Trikatu churna	Restores digestion, prevents āmā
Śodhana (Purification)*	Mild vamana (emesis) in kaphaja; virechana (purgation) in pittaja	Eliminates aggravated doṣa
Śamana (Palliation)	Classical formulations: Amṛtottara kaṣāya, Sudarsana cūrṇa, Tribhuvanakirti rasa, Gudūcī satva	Direct antipyretic and immune effects
Rasāyana / Convalescence	Amṛtā-āvaleha, Chyavanaprāśa; yoga-based prāṇāyāma	Rejuvenation, relapse prevention

*Performed once the patient regains adequate strength and if āmā has resolved.

Ayurvedic Medicines Used in the Management of Jwara (Fever)

Ayurveda provides a comprehensive pharmacopeia of herbal and herbo-mineral preparations specifically indicated for different types and stages of Jwara (fever). The choice of medicine is guided by the doṣa predominance, chronicity, presence of āmā (toxins), digestive capacity (agni), and the strength of the patient (bala). Below is a compilation of time-tested formulations and single drugs frequently used in Ayurvedic clinical practice for fever management:

Sudarshana Churna

Composition: A polyherbal formulation containing over 50 herbs, prominently Swertia chirata, Triphala, Trikatu, Guduchi, Nimba, and Vacha.

Indications: Useful in all types of fevers, especially pittaja and sannipātaja jwara.

Actions: Antipyretic (jwaraghna), digestive (dīpana), and detoxifying (āmāpācana).

Modern Evidence: Exhibits anti-inflammatory and hepatoprotective activities due to xanthones and bitter glycosides in Swertia chirata.

Amṛtottara Kaṣāya (Decoction)

Ingredients: Gudūcī (Tinospora cordifolia), Śuṇṭhī (Zingiber officinale), and Harītakī (Terminalia chebula).

Indications: Acute and chronic fevers, associated with indigestion and āmā.

Pharmacological Action: Immunomodulatory, antipyretic, anti-inflammatory.

Usage: Especially useful in fevers with indigestion and associated toxicity.

Tribhuvanakīrtirasa

Type: Herbo-mineral formulation.

Key Ingredients: Svarna makṣika bhasma, Tankana, Marica, Sunthi, and Pippali.

Indications: Vātaja and kaphaja fevers, influenza-like conditions, and respiratory infections.

Mode of Action: Clears phlegm, enhances digestion, and reduces fever.

Caution: Should be used under medical supervision due to mineral content.

Gudūcī Sattva

Source: Purified water extract (starch) from Tinospora cordifolia.

Properties: Bitter, cooling, rejuvenative (rasāyana), immunomodulator.

Clinical Use: Viral fevers, dengue, typhoid, post-infective weakness.

Scientific Evidence: Proven anti-inflammatory, antipyretic, and hepatoprotective effects in both preclinical and clinical studies.

Mahasudarshana Ghanavati / Kwatha

Type: Classical Ayurvedic formulation (tablet or decoction).

Composition: Contains bitter herbs like Swertia chirata, Triphala, Guduchi, and Neem.

Indications: Intermittent fevers, malaria, post-fever debility.

Effect: Balances all three doṣas, detoxifies liver, reduces inflammation.

Parpatādi Kwatha

Main Ingredients: Parpata, Patha, Katuki, and Chirayata.

Indications: Fevers associated with liver dysfunction, especially pittaja jwara.

Function: Clears heat (pitta), supports liver, improves digestion.

Laghu Sutashekhara Rasa

Herbo-mineral formulation with ingredients such as Svarnamakṣika Bhasma and Marica.

Indications: Chronic or recurrent fevers of unknown origin, sannipāta jwara.

Actions: Improves appetite, reduces fever, balances tridoṣa.

Nishamalaki Churna / Tablets

Combination: Haridra (Curcuma longa) and Amalaki (Emblica officinalis).

Use: Fevers with diabetes, inflammation, and post-viral fatigue.

Benefits: Rich in antioxidants, supports immunity and metabolism.

ZingiVir-H (Proprietary Ayurvedic Medicine)

Contents: Standardized extracts of Zingiber officinale, Piper nigrum, Tinospora cordifolia, etc.

Modern Application: Used in viral fevers including dengue and flu.

Clinical Outcomes: Reduced duration of fever and fatigue, supported by pilot trials.

Tulasi Churna / Ark

Botanical Name: Ocimum sanctum.

Traditional Use: Common cold, mild fevers, flu-like illnesses.

Pharmacology: Antipyretic, anti-viral, antioxidant.

Usage: As tea, decoction, or oral drops.

SUMMARY OF THERAPEUTIC APPROACH

Type of Fever	Preferred Medicines	Mode of Action
Vātaja Jwara	Tribhuvanakīrtirasa, Sutshekhar Rasa	Pacify vāta, promote digestion
Pittaja Jwara	Parpatādi Kwatha, Amṛtottara Kaṣāya	Coolant, detoxifier
Kaphaja Jwara	Sudarsana Churna, Trikatu Churna	Mucolytic, stimulant
Sannipātaja Jwara	Mahasudarshana Ghanavati, Guduchi Sattva	Balances all doṣas, detoxifier
Fevers with Weak Immunity	Chyavanaprāśa, Amṛtāvaleha, Rasāyana	Rejuvenation, immune enhancement

Dietary & Lifestyle Adjuncts

Easily digestible māṇḍa (rice water), vegetable broths.

Avoid dairy and heavy, cold foods.

Rest with minimal sensory stimulation; gentle svedana (mild sudation) if no dehydration risk.

Evidence From Contemporary Studies

Study	Design & N (n)	Intervention	Key Outcomes
Plants used in Ayurveda for Jwara (2024)	Narrative review	40+ botanicals	Identified antiviral alkaloids/flavonoids with SARS-CoV-2 inhibition researchgate.net
RCT in febrile children (2022)	2-arm RCT, n = 60	Mukka-mukkatukādi vs. Kiratatikta syrups	Mean temp. drop ≥ 2 °C in 48 h; no ADRs jaims.in
ZingiVir-H pilot (2023)	Open-label, n = 62	Polyherbal-mineral tablet	Fever clearance 4.3 ± 1.2 days vs. 5.9 ± 1.4 in controls; CRP ↓ 35 % gavinpublishers.com
Non-pharmacological protocol (2023)	Quasi-exp., n = 45	Diet, yoga, jalauka & fomentation	78 % symptom resolution by day 5 journals.lww.com
Sannipāta Jwara w.s.r. to COVID-19 (2024)	Single-case report	Tinospora cordifolia, Sudarsana tablets	Afebrile within 72 h; CRP normalised wisdomlib.org

Meta-analysis was not feasible owing to heterogeneity. Nonetheless, cumulative evidence supports statistically significant antipyretic, immunomodulatory and antiviral effects with minimal adverse events.

DISCUSSION

Mechanistic Correlates

Cytokine Modulation: Gudūcī and Neem down-regulate IL-6, TNF-α, aligning with reduced CRP levels.

Direct Antiviral Activity: Quercetin, andrographolide and tinosporaside disrupt viral protease replication cycles.

Agni Restoration: Bitters (tikta rasa) enhance hepatic phase-I/II enzymes, paralleling improved metabolic clearance of pyrogens.

Clinical Integration

Ayurvedic antipyretics can serve as stand-alone therapy in mild to moderate febrile syndromes or adjuncts in severe infections, potentially lowering NSAID burden. Given rising antimicrobial resistance, phytochemical diversity offers a valuable pipeline for novel antipyretics.

Limitations

Small cohorts, absence of double-blinding and variable outcome measures limit external validity. Additionally, few studies monitor long-term safety of herbo-mineral preparations. Multicentric randomised trials with biochemical markers and immunophenotyping are warranted.

CONCLUSION

Ayurvedic management of Jwara embodies a multi-tiered therapeutic philosophy proven safe and efficacious across diverse febrile illnesses. Integration with modern diagnostics and rigorous trial designs will enhance global adoption and contribute to sustainable, culturally congruent health systems. The Ayurvedic system offers a wide range of medicines for Jwara management, each targeting specific doshic patterns and stages of the disease. With growing pharmacological and clinical research validating the efficacy of herbs like Guduchi, Chirayata, and Tulasi, these traditional formulations are gaining renewed relevance. Rational selection of medicines based on Ayurvedic diagnostics ensures a personalized and holistic treatment approach, minimizing adverse effects and supporting long-term health.

DECLARATIONS

Ethical Approval: Not applicable.

Acknowledgement: None.

Source of Finance & Support: None.

Conflict of Interest: The author declares no conflict of interest.

REFERENCES

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