Jwara (fever) is the lord of the diseases, born from sin, causing death, feeds on ojas, lead to the final end...characterised by santapa (discomfort from heat), arising from improper conduct; is a cruel one, affecting all species of living beings and called by different names. (1)
In the Charak Samhita, Puranvasu explains that fever originated when Daksha, King of Kashi, excluded Shiva from his sacrifice. In his anger, Shiva emanated a boy who, heated with the fire of anger, could destroy Daksha's irreverent sacrifice. Once Shiva calmed down, the emanation of his fire of wrath, possessed of three heads and nine eyes, holding a weapon of ashes and surrounded by flames, needed a job. Shiva told him, "You will be fever in the world." (2) Since then the emanation of Shiva's wrath has run around the world making immense trouble. Just in terms of influenza alone, there are 250,000-500,000 new cases each year in the United States, with a resultant 20,000 deaths and 200,000 hospitalizations annually. (3) The 1918 pandemic flu was more lethal that World War I, killing from 20,000,000 to 50,000,000 people in two short years. The magnitude of the health challenge presented by influenza and its common incidence render it an extremely important topic, particularly in the winter months when epidemics of influenza tend to occur. In this article we will consider differences in how Ayurveda and biomedicine see influenza, complementarity between the two, benefits of influenza, hazards of influenza, prevention, treatment, aftercare and pandemic influenza.
Differences in How Ayurveda and Biomedicine See Influenza
The biomedical approach to influenza is based in the sciences of virology, biochemistry and microbiology. From this standpoint, it is important to know the exact virus that caused the flu-like illness and the exact mechanisms of infectivity, transmission and morbidity or lethality of this virus. Viral cultures, immunofluorescent tests and serologic studies are required in order to make a definitive diagnosis. The disease entity characterised as influenza is caused by a single-stranded RNA virus, the influenza virus, which is subdivided into type A or B (causing epidemic flu) and type C (causing sporadic flu). Influenza is transmitted via the respiratory secretions over a time period from one day before until about five days after the onset of the disease. Non-influenzal flu-like illnesses are caused by other viruses, notably the adenoviruses, double-stranded DNA viruses which can survive for long periods of time in house dust and cause flu-like illnesses on an endemic basis throughout the year. The Ayurvedic approach to influenza is based on the prakruti-vikruti paradigm and emphasises the condition of the host rather than the nature of the infective agent. Diagnosis depends not on serology and virology but on the age old methods of darshanam, sparshanam and prashanam, (observation, palpation and questioning). Two individuals affected with the same virus will likely receive a somewhat different Ayurvedic diagnosis, depending upon their presenting features. Strictly speaking, Ayurvedists should stay away from the word influenza (a diagnosis rooted in virology). From the Ayurvedic standpoint, the abhisanga (external)cause or infective agent (personified as Shiva's anger-emanation) is still less important than the pre-existing doshas and ama. The infective agent is the seed but ama is the fertile field in which the seeds can sprout. As Vagbhat describes the pathogenesis of fever, Doshas, getting increased by their respective causes, enter amashaya (the stomach) combine with ama, obstruct the channels, drive the fire to the exterior and moving along with it make great increase of heat in the body. (4)
Based on the symptom picture, the fever is characterized as arising from vata, pitta, kapha, a combination of two doshas or all three (sannipata). A typical influenza might fit the description of a pitta-kapha fever, with symptoms of shivering, stiffness, sweating, burning sensations, thirst, cough, and elimination of phlegm and yellow or green secretions. (5) A pandemic influenza of high lethality would fit the picture of incurable sannipata jwara, with stupor, expectoration, vomiting and exhaustion. (6) Ayurvedically, it is also important to be aware of which dhatu is being affected by jwara. Acute fevers move swiftly through the astayi dhatus, penetrating deeper and deeper, giving rise to the ever changing symptom picture of flu-like illnesses as the symptom complexes of each dhatu appear sequentially. Initially there might be the body aches and nausea of rasa jwara, soon followed by the high fever and prostration of rakta jwara. This may be followed swiftly by fainting as doshas enter mamsa dhatu. The author recalls passing out on the London Underground during the pandemic flu of 1969! Soon after comes the onset of anorexia, thirst, malaise and sometimes vomiting as doshas reach meda. In more serious flus the intense bone pain and breathlessness of asthi jwara may follow and in extreme cases influenza may lead to encephalitis, an all-out majja jwara. (7)
Complementarities between the two views
In contemporary practice, the two views of influenza complement each other. Virology, biochemistry and phytochemistry offer the Ayurvedist valuable insights (8) in the selection of herbs that will be active against viral illnesses. For example, knowing of the impressive antiviral resumes of herbs such as Turmeric, Tulsi and Neem may lead us to include these herbs in our influenza chikitsa, while taking their rasa, virya and vipak into account within the prakruti-vikruti paradigm. At the same time, Ayurveda offers biomedicine and Western herbology potential answers to the question why only some exposed individuals will actually develop influenza, why some will be worse affected than others and why some are harmed by the same treatment that benefits others. A mother arrived in my clinic very concerned because her young daughter had not recovered from a flu-like illness despite dosing with Echinacea, which cured her step-brother. We discontinued Echinacea and she spontaneously recovered. As a vata, she was adversely affected by Echinacea, a bitter and pungent herb that was beneficial for her kapha step-brother.
Benefits of Influenza
From a biomedical standpoint, influenza has an effect in priming the immune system, raising levels of interferon that help combat other viral challenges. A small child's frequent flu-like illnesses are a kind of immunological curriculum, training their immune system to recognize and combat a wide range of viruses. From an Ayurvedic standpoint, it is important to distinguish between prakrta and vaikruta fevers. Prakruta fevers occur at the change of seasons in Spring and Fall and are the body's way of expelling excess doshas. These fevers are typically in the category of abhaisaja sadhya or illnesses that spontaneously remit without medicine. Suppressing these natural fevers leaves the doshas no way of being expelled and sets the stage for the onset of more serious conditions. On the other hand, vaikruta fevers occur unseasonably (such as kapha flu in summer) and should be treated vigorously as they represent an inherent imbalance. (9)
Hazards of influenza
Influenza is particularly troublesome in older adults (over fifty), in respiratory-compromised individuals such as asthmatics, in immuno-compromised situations like HIV and in those with chronic illnesses such as diabetes and heart disease. These groups are more likely to develop significant pranavahasrotas disorders such as bronchitis and pneumonia as a consequence of catching flu. In light of these dangers, prevention is an important aspect of the approach to influenza.
In working with those in the risk categories discussed above, it is particularly important to address influenza prevention during the fall and winter. An herbal formula to detoxify rasa and rakta and stimulate the immune response with herbs such as Pippali, turmeric, and Triphala, will be of value during this season. Immune Support is a combination that includes these traditional herbs as well as Echinacea and Osha, which have known effects in stimulating the immune system. Daily use of Chyavanprash during flu season is very traditional and will help maintain the health of pranavahasrotas and fight off flu. A home-made "Trinity Tea," as we like to call it, is a tasty combination of Tulsi, Turmeric and Ginger to make a warming and anti-viral beverage for use in the winter months, particularly for the at-risk populations. Of course, regular panchakarma at the change of seasons takes flu prevention to another level. Shodhana therapies expel the excess accumulated doshas, removing the need for the body to expel them through a prakrta fever.
Influenza is treated by langhana (reducing) therapies, particularly fasting (10). Loss of appetite during fever is a response of cellular prajna since agni has become externalized and is unable to digest solid food. A small child whose parent s encouraged her to eat during an influenzal fever developed sores on her mouth and tongue. These immediately abated when she was asked to fast for a short while and sip Fennel tea. While fasting, the patient should sip warm water frequently and should avoid cold water, which will cause further accumulation of vata and kapha. In the case of a strong pitta fever, room temperature water can be sipped. (11) Herbal teas containing Musta and Ginger are ideal. Musta is regarded as the pre-eminent herb for fevers (12). Cooling herbs are added to this blend, traditionally sandalwood, now unavailable for sustainability reasons. Rose and Coriander can be substituted to provide the cooling anti-febrile component. The texts emphasize that no solids, including powdered herbs, be taken at this time. (13) Sweating is applied using a ginger bath or sauna but oiling or lepana should not be applied. As the fever comes down and appetite begins to be felt, the patient should use bitter herbs such as Mahasudarshan to dispel toxins and can consume a thin gruel containing digestive spices such as Ginger, Coriander, and Pippali(14). Kapha should add Dashamoola to these recipes. (15) Traditionally the reintroduction of foods progresses from manda (a liquid gruel) to peya, or semisolid gruel to yavagu or soup with boiled grains to vilepi, somewhat soupy boiled grains and finally to odana or solid boiled grains. (16) Vata and pitta can use rice for these recipes while kapha should use barley instead. Mung dal can also be used for the gruels while for gluten sensitive kaphas we have had good results substituting quinoa for barley in the traditional recipes. Non-vegetarians can also use chicken soup ('Jewish penicillin') as a substitute for the quail soup mentioned in the texts (17). Maya Tiwari's book Secrets of Healing contains recipes for the traditional gruel preparations of manda, peya etc. showing how to use spices such as cumin, coriander, turmeric and mineral salt in the recipes. Following the reintroduction of food, it is wise to use rakta shodhan or blood cleansing herbs such as Guduchi and Musta (18) or a formula such as Blood Cleanse and to take Triphala to expel residual doshas.
Following influenza the patient may be debilitated for weeks, even if they shook off the initial fever in a few days. At this time it is best to remain celibate, to continue an easily digestible diet and to introduce physical exertion gradually (19). Walking can be increased from slowly strolling around the block to gentle walks. Restorative yoga will also be helpful. Lung rejuvenative herbs such as Licorice, Pippali or Lung Formula are of value at this time, to clear up residual cough and upper respiratory symptoms and strengthen pranavahasrotas. The post-flu formula par excellence is Chyavanprash, which heals the lungs, boosts immunity and restores strength and energy. Post-influenzal depression arises from penetration of the virus and disease process into majjavahasrotas and is best addressed by a tea combining equal portions of Brahmi and Tulsi.
A Word about Pandemic Influenza
Influenza viruses responsible for causing pandemics are influenza A viruses which emerge as a result of a process called "antigenic shift" causing sudden, major change in certain proteins on the surface of the influenza A virus. This change is great enough that the body's immune system finds the new virus unrecognizable. Much of the severity of pandemic flu may result from over-reactivity of the immune system, a process known as 'cytokine storm' which results in severe lung damage and ultimately necrolysis of the vital organs. (20) In this situation it is vital to avoid immune stimulants such as Echinacea or Immune Support which are so valuable in epidemic and sporadic influenza. Honey should not be used for the same reason. Turmeric is the ideal herb to use in this situation since it will both fight the virus and calm the immune response.
As we have seen, biomedicine and Ayurveda view influenza through different lenses and yet the two approaches can complement each other. Ancient texts provide detailed instructions regarding the prevention, treatment and aftercare of influenza.
Astanga Hridayam of Vagbhat, nidansthanam ii ,v1-2 tr. Srikantha Murthy, Chowkhamba Krishanadas Academy, Varanasi, 2003
Charak Samhita, Chikitsasthanam, iii v15-25 tr. PV Sharma, Chaukhamba Orientalia, Varanasi1994
Hakan Leblebicioglu, MD http://www.emedicine.com/ped/TOPIC3006.HTM
A. H. op cit nidanasthanam ii3-6
ibid, ii v26
ibid ii v 35-37
C.S. op cit chikitsasthanam ii 75-83
Amritpal Singh, Reviving the Dravyaguna Curriculum, Light on Ayurveda Journal Fall 2008 Vol. 7 issue 1 p 37-39
C. S. op cit chikitsasthanam ii42-49
A.H. op cit chikitsasthanam i v 1-2
ibid v 11-13
ibid v 18-19
ibid v 21-22
ibid v 24-26
ibid v 26-34
C.S. op cit chikitsasthanam ii v 190-193
A.H. op cit chkiitsasthanam i v 26-29
ibid v 174.
Osterholm, Proposed Mechanism of the Cytokine Storm Evoked by Influenza virus. New England Journal of Medicine, 352 (18): 1839, Figure 3. May 5, 2005
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Alakananda Ma M.B., B.S. (Lond.) is an Ayurvedic Doctor (NAMA) and graduate of a top London medical school. She is co-founder of Alandi Ayurveda Clinic and Alandi Ayurveda Gurukula in Boulder Colorado, as well as a spiritual mother, teacher, flower essence maker and storyteller. Alakananda is a well known and highly respected practitioner in the Ayurveda community both nationally and internationally.
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