Introduction
Regulation of the overall natural immune response to deal with the challenges such as fast mutation, antigenic shift, and cytokine storm, of the recent prolonged epidemic, is the need of the hour.[1–3] Fever is a primary response of the immune system to infections.[4] Ayurveda depicts immunity through bala (strength) and its preservation in the treatment of jwara, which resembles fever.[5] The objective of the study is to establish a treatment protocol of jwara as an immunity regulator in infections from the perspective of bala. Another aim is to verify the safety and efficacy of each component of the protocol and its significance as a whole.
Materials and Methods
Classical ayurvedic texts were searched for the reference of jwara and related aspects. The physiology of fever, jwara, and assessment of the impacts and detriments of each component of the treatment were explored via an electronic search. Contemporary studies appraising the physiological evidence, therapeutic, and immunological significance of the jwara treatment were selected. Ayurvedic review articles were selected based on the detailed classical compilation with appropriate interpretation of terms. Studies were identified by searching PubMed, ScienceDirect, and Google Scholar using the following combination of keywords: (Jwara OR Yavagu OR Nasya OR Taste OR Fasting OR Dhoopana OR Anjana and immunity).
Understanding the resemblance between jwara and fever
The following sections will provide an overview of several common etiologies of jwara and fever, followed by the treatment protocol of jwara, supporting its incidence in any type of fever and the context of bala in the jwara treatment as an immunity regulator. For this article, the term jwara is used in the ayurvedic context and not used as a synonym for fever, pyrexia, and hyperthermia.
Classification
Jwara is considered the most grievous disease because it affects the body, mind, and senses also. It appears as the earliest sign of any somatic disease or as a primary disease. The slight elevation of the temperature of a fetus just before the birth and in the early postmortem period after death is also recorded by classics.[6,7]Neeja jwara or endogenous-origin jwara (EnJ) is caused due to the disparity of dosha and agantuka jwara or exogenous-origin jwara (ExJ) is caused by external factors such as infections and injuries.[1] Fevers are broadly classified as infectious and noninfectious origin.[8] The remittent, intermittent, quotidian, and tertian fevers have a similar pattern to Santata, Satata, Anyedushka, Tritiyaka, and Chaturthaka jwara, respectively. Insignificant to the cause, they were named vishama jwara (VJ).[9]
Pathophysiology
The vitiated vata, pitta, and kapha dosha (regulators of every function of the body) either alone or in combination with ama (undigested/abnormal metabolites) and rasa dhatu (primary product of the digested food) cause displacement of jatharagni (energy that drives metabolic processes) existent in pachaka pitta (subtype of pitta essential for biotransformation) and affect the circulation of sweda (sweat), manifested as jwara. The pathogenesis and treatment of ExJ and EnJ primarily differ according to the cause and are identical after the involvement of dosha.
Fever is supposed to be a host response against infectious diseases, which promotes the synthesis of antibodies and cytokines and the activation of T cells, neutrophils, and macrophages to reduce bacterial growth.[10] In addition, the generation of fever is the interaction of the immune system with the nervous system via multiple endogenous mediators such as cytokines, in which some act like pyrogens and others as antipyretics in a response to infection, inflammation, and trauma.[10,11]
Diagnostic value of signs and symptoms
The symptoms of prodromal phase (purva rupa), illness phase (rupa), decline phase (pachyamana), and convalescence phase (upashaya) of each type of jwara with their respective pathogenesis (samprapti) have been depicted as per the dominated dosha to ease the diagnosis.[6] In general, vata represents the nervous system, pitta represents biotransformation, and kapha represents accumulation-related symptoms. Anorexia (aruchi) is the first sign of disturbed metabolism (agni) that causes ama, the root cause of jwara. Sushruta described anorexia, burning eyes, and excessive yawning, and by Charaka include astringent (Kashaya), bitter, and sweet mouth taste for kapha-, pitta-, and vata-dominant jwara, respectively. The incidence of all the described primordial symptoms with or without jwara indicates higher mortality. They anticipate the severity and the fatality of the disease and expect immediate actions, such as evading the cause, dietary modifications for protection of agni (metabolism), and to prevent further disparity of dosha.
Anorexia and taste aversion in infections is a part of energy homeostasis induced by cytokines, especially interleukin (IL)-18, which can modulate both innate and adaptive immunity and its dysregulation can cause autoimmune or inflammatory diseases.[12,13] Sickness syndrome, such as fever and chills, malaise, myalgia, sneezing, cough, runny nose, sinus pain, congestion, headache, is the result of the secretions of different immune cells such as ILs, pyrogenic cytokines, and interferons to the infection, initiated by the host and not by the infectious agent.[14] Some studies noticed the variability in the symptoms and patterns of the fever due to the same pathogen.[15,16]
Impact of circannual variations and biological rhythms on immunity
Various factors such as strength, constitution, diet, age of the individual, the existing season, and locus (desha) of the host influence the intensity of symptoms. The strength of the host and the circadian and biological rhythms of dosha can change the pattern of VJ despite the same etiology. For example, the remittent pattern of vata-dominant jwara in monsoon can change to intermittent pattern in autumn.[17,18] Various studies have also found the impact of circannual variations, biological rhythms, and the locus through variable environmental adaptations of the cellular composition of the immune system in human populations and seasonal variations in blood inflammatory biomarkers, such as C-reactive protein, white blood cell, and neutrophils.[18–21]
Physiology of thermoregulation and functions of pitta
With the help of core and skin thermoreceptors, the hypothalamic thermoregulatory center monitors internal and surface temperature changes, respectively. By metabolic and mechanical mechanisms, chemical energy in foods is converted into body heat, which is conserved by vasomotor changes through vasoconstriction and by regulating the blood flow to the skin and mucous membranes and by sweating.[9] Mitochondria convert fat into energy in cold temperature and heat loss is decreased by shivering, piloerection, and impeding sweat.
Pitta regulates the ushma (body temperature) of the body, which is responsible for digestion and metabolism. The normal core body temperature is maintained by harmonizing the sheeta (coolness) and ushna guna (hotness) via vata in association with pitta and kapha. Sweda (sweat) is the waste product (mala) of fat (meda) and the site of pitta.[22] Shivering is the sign of hypoactivity of pitta, while piloerection is a symptom of decreased sweating.[23]
Understanding hyperthermia, pyrexia, and hyperpyrexia in accordance with jwara
The normal body temperature refers to either the core temperature of the deep tissues of the body or peripheral temperature which fluctuates by many factors.[24] The rise in core temperature during fever is discrete from the unregulated rise that occurs during hyperthermia, where pyrogenic cytokines are not directly involved and against which standard antipyretics are largely ineffective.[25] The symptoms of hyperthermia are similar to that of EnJ types, Pittaja jwara, agneya jwara, and bahirvegi jwara described by Charaka and to sunstroke described as ushmaghata and atapadi dagdha by Yogaratnakara and Sushruta, respectively.[26]
External treatments for maintaining temperature in jwara and fever
External treatment such as cold or hot (by quality or by function) external applications, water sprinklers, and immersion are indicated as per the desire and strength of the patients and advised only for jeerna jwara (JJ) (after 8 to 10 days of the onset of jwara), irrespective of the body temperature. It depends on the psychosomatic triggers such as physical cooling which is contradicted for the jwara triggered due to cold things (cold beverages, cool climate, cold water showers, etc.) and beneficial if it is triggered due to hot things (hot and spicy food, hot climate, annoyance, etc.).[27] However, the conventional physical cooling methods such as tepid sponging, cooling blankets, iced/tepid water emersion, ice gastric lavage, and peritoneal lavage have a difference of opinions about the methods, the temperature, and the hemodynamic conditions. An increased risk of mortality in septic intensive care unit patients, requiring mechanical ventilation, has been noted due to external cooling.[28]
Summery
Unlike fever, jwara is described as a disease and not the response of the host. Classics reveal the discriminative knowledge of fever, contagious diseases, infections, epidemics, and pandemics with a distinct treatment protocol according to the category and phase of jwara.[9] Although the pathophysiology of jwara and fever differs, both sciences relate thermal energy as a metabolic process and the role of fat in the conversion of heat. The diagnostic and clinical value is given to the primordial symptoms and pattern of jwara and fever. The variability of symptoms is seen to be a subjective matter and also depends on the seasonal adaptivity of the host. Both the sciences accept that the early understanding of primordial symptoms and consequent dietary and behavioral changes are preventive and may help in the regulation of cytokine secretions. According to Ayurveda, physical cooling or warming is consequential to the subjective expressions of hot and cold, which is not considered by contemporary science.
Understanding the treatment protocol of jwara and antipyretic treatment
The protocol of the jwara treatment is biphasic. The first 7–8 days from the appearance of jwara is considered the first phase (taruna jwara [TJ]) and after 8–10 days of appearance, it is called the second phase (JJ). The treatment protocol as a whole and in the specific order is expected for the effective mode of action. TJ treatment aims dosha pachana (remittance) through langhana (specific light diet), swedana (sudation), yavagu (authentic functional food), and tikta rasa (bitter taste) diet according to the kala (season and stage of the disease), and is reliant on the bala (strength of the host, and the disease). The treatment protocol differs for the second phase (JJ), VJ, and ExJ. It aims to eliminate the jwara through medicines and focuses more on the strength of the host through brihana (nourishment) in contrast to langhana (specified diet). No medicines are suggested for the first phase of jwara with expected remittance within 8–10 days.
Contrasting attributes and the incorporation of the involved dosha, dhatu, and agni make jwara dreadful. The challenge of the treatment is to abate ama without tampering rasa dhatu (primary tissue), to subside the excess heat of pitta without lowering other attributes of pitta, and to stimulate agni without provoking pitta for the restoration of the rasa dhatu, pitta, and sweda. In other words, the heat of pitta causing jwara is also essential for tissue-specific metabolism and elemental-level metabolism. Reducing the heat (thermal energy) without reducing the metabolic function of pitta is expected.[29]Agni and pitta hold the same qualities, hence stimulation of agni without provoking pitta makes the remittance delicate. The treatment modalities such as langhana and swedana to abate ama present in rasa dhatu that nourishes the body, may result in malnourishment or affect the heart. The entire treatment goes along the strength of the agni and bala (physical strength), which marks its significance.[30]
The treatment of fever generally begins with antipyretics followed by disease-specific treatment like antibiotic, antiviral antifungal, etc. Antipyretics block or reverse cytokine-mediated rise in core temperature and may constraint the diagnostic and prognostic signs of the disease that can increase the risk of mortality.[31]
The following sections will provide potential strategies for addressing the treatment protocol of jwara and its relevance to immunity with the help of physiological action of the protocol. The knowledge of impacts and detriments of each part of the treatment signifies the follow the protocol with Ayurvedic principles is necessary to check the efficacy as well as contemporary studies.
Langhana, other dietary regimens, and immunity
Out of the ten types of langhana, four types of shodhana (vamana, virechana, shirovirechana, and niruha), pachana, and fasting or eating a specific diet are instructed in the treatment protocol of jwara. For the first phase of jwara or EnJ, langhana, eating according to the appetite until tolerable, has been suggested to increase the strength of the host, with some exceptions.[32–34] It is specified according to the constitution (not advised for vata constitution), stage of fever (until remittance or up to 10 days after the onset of jwara, whichever is earlier), the strength of the host, and intensity of dosha (minor dosha – langhana with instructed diet, moderate – langhana with pachana medicines, and major – shodhana). It declines jwara, arouses taste, intensifies hunger and thirst, and causes sweating. Exercise and sun exposure, the types of langhana, are not recommended until the recovery[35] Also, depending on the intensity and duration, exercise can hamper immune mechanisms.[36] Increased fatigue with decreased interest in food, socializing, and sex is a response of the immune system of sick humans to meet the increased energetic demands.[15] Various dietary restriction regimens, such as caloric restriction, periodic fasting, intermittent fasting, and alternate-day fasting, have found positive and negative impacts on the immune system.[37,38] The positive results include the generation of immune system cells such as T cells, B cells, and natural killer cells and regulation of the self-renewal and pluripotency of stem cells.[37] Furthermore, intermittent fasting does not affect the weight and prolonged fasting can regenerate and protect against immune system damage.[38]
Compared to other food regimens, langhana is the consumption of a specific tasting recipe, subjective to the appetite, with no fixed calories, or days, or do not expect complete food abstention. Injudicious langhana can be fatal due to the depletion of the strength of the body and agni.[39] Undernutrition can impair immune function, but the extent of impairment of immune function due to undernutrition depends on the severity of the deficient nutrients, the presence of infection, and the age of the subject.
Various approaches of swedana for thermoregulation
Body heat is a by-product of metabolism, and excess body heat is dispelled chiefly by increasing blood flow to the surface and extremities by sweating.[8]Swedana, the scientific sudation, is also one of the symptoms of absolute langhana and is categorized under nonexercise-related thermogenesis.[22,40] There are two distinguished methods of swedana, the first niragni (10 types) or nonthermal sudation, and the second Saagni (13 types), which utilizes various methods of dry or moist heat.[41] The latter method is indicated for the sheeta jwara caused due to cold properties.[42] Out of the ten nonthermal sudations, room warming, heavy clothing, langhana, and hot diets (by property/potency) such as consumption of warm and processed water and food are indicated.
Excess swedana can augment pitta, and cause a burning sensation, diaphoresis, muscle weakness, etc., A pilot observational study done to check the hemodynamic effects of saagni sweda (not advised in jwara), noted elevation of blood pressure immediately after the swedana procedure and reduction in the systolic blood pressure after continuation of therapy for few (7) days.[43] No clinical study is found on nonthermal sudation.
Recent immunohistochemistry studies also suggest the immunological significance of sweat glands that produce and excrete antimicrobial peptides such as dermcidin, cathelicidin, and lactoferrin, pointing to a potential role of sweating in host defense against skin infection.[44]
Resemblance between kala (time) and immunity
Kala denotes the phase (TJ and JJ) and the stage of the jwara (ama/pachymana), which changes the perspective of treatment and diet. The remittance or mortality of jwara is anticipated within 3, 7, and 10 days by Charaka or within 14, 18, and 22 days for santata jwara by Vagbhata for vata, pitta, and kapha, respectively.
The range of duration of fever in patients with SARS was 11.4 days and MERS was 8 days, while in SARS-CoV-2, radiological worsening was detected within 7 days after the onset of symptoms of the first phase of consistent fever. Symptoms began to relieve in 2 weeks in most of the patients and normal body temperature was noted 10 days after the onset of symptoms in half of the patients.[17] In addition, CD8 T cells which play a critical role in mediating viral clearance typically reach peak numbers at approximately day 8 for respiratory syncytial virus, day 10 for influenza A virus, days 10–14 for human meta-pneumo virus, and days 12–14 for pneumonia virus of mice, a model respiratory virus.[45]
Dietary regimen of jwara as functional food and nutraceuticals
In Ayurveda, various processing techniques are suggested to alter the physiological effect of the food. The suggested jwara diet is discussed herewith to evaluate its clinical efficacy.
Water
Drinking processed warm water (shadangodaka) is energizing,appetitive, clears clog, eliminates dysgeusia, diaphoretic, lifesaving and has anti-jwara properties.[46] A study done on dehydrated healthy subjects noted that the thermoregulatory response varied according to the ingested water temperature. Drinking warm (58°C) water showed a higher sweat rate and induced lower intake compare to drinking cold (5°C), cool (16°C), and tepid (26°C) water.[47]
Yavagu
The treated rice gruel (28 types) with or without tikta rasa (different opinions) is indicated without starch (siktha) for TJ until the severity or for 6 days to stimulate the agni and with starch for JJ as a diet.[48] It is contraindicated for alcoholics, in the summer season and epistaxis. Starch molecules permit greater enzymatic digestion by the activity of enzymes such as amylases.[49]Manda, peya, vilepi, and yawagu, the types of starchy preparation of rice, have a different consistency with different water ratio that modifies the digestibility of carbohydrates and glycemic responses.[50,51] Furthermore, the water-soluble polysaccharides of starch either enhance or activate the responses of macrophages and complement the immune system. Manda, peya, vilepi, and yawagu are described as anti-jwara, while yusha and mamsa rasa as balya and not anti-jwara.[52] Rice rehydration is four times more effective than glucose and it is highly nutritious than wheat.[51]
Rakta Sali
Red rice is an anti-jwara component and is a preferable rice recipe for jwara like yavagu.[53] It is rich in iron (Fe), zinc (Zn), and minerals, and its anthocyanins or colored pigments and flavonoids are associated with antioxidant properties.[54] Brown rice gives a low postprandial glucose response compared to white rice and red rice flour has high protein, fat, and dietary fibers compared to other starches and a single meal is described to be sufficient for long hours of hard physical work.[55–57]
Yusha
The sour taste (amla rasa) soup of legumes (yusha), medicinal ghee, and specified meat soups with red rice are advised in the second phase or JJ, sheeta jwara; for the initial stage of VJ, and also as a replacement for yavagu in certain situations.[58,59] They are a rich source of proteins and responsible for diet-induced thermogenesis.[23] A variety of yusha are advised according to the diseases.[60] Meat soup improves the potency of the tissues (dhatu),[39] required for degradation of the intensity or eradication of discrepant dosha.[32] Prolonged fever for over a week causes a breakdown of endogenous fat stores and uses body proteins as an energy source, that may develop metabolic acidosis accompanied by a negative nitrogen balance and dehydration.[8] The metabolic rate increased by a high protein diet is more than that a meal of carbohydrates and fats and lasts for 3–12 h.[61]
Tikta (bitter) and Madhura (sweet) Rasa and immunity
Indication of different rasa (taste) diets in different stages of jwara has a prognosis value. Tikta rasa (bitter taste) is indicated for the first phase of jwara with restriction of madhura and kashaya rasa (astringent taste), while madhura and amla rasa (sour taste) are indicated in hyperthermia. Tikta rasa is digestive, appetitive; eliminates dysgeusia, pus, itching, burning sensation, and declines perspiration, thirst and volume of urine and stool. It is also antitoxic and germicidal and alleviates skin diseases and jwara, etc.[62,63] Excess amount of tikta rasa can dehydrate tissues, causing emaciation, unconsciousness, giddiness, and vitiation of vata. Madhura rasa is satisfying, in that it is a lifesaver, an instant energizer, a nourisher, a stabilizer, and a wound healer and upsurges all tissues and oja. Excess of madhura rasa hampers agni and causes anorexia, sheeta jwara, respiratory tract disorders, vomiting, conjunctivitis, etc., Research supports the opposite role of sweet (T1R) and bitter (T2R) taste receptors in early innate immune responses in the airway and other places such as nose sinuses, lungs, gastrointestinal tract, and brain.[64,65] The bitter taste receptors mediate cellular responses to most hormones, metabolites, cytokines, and neurotransmitters with immediate recognition of pathogens and stimulate phagocytosis within minutes.[65,66] Sweet taste receptors are thought to inhibit antimicrobial peptides, when the pathogens use glucose as an energy source.[67] Elevated airway surface liquid glucose concentration in diabetic patients, makes them more prone to airway infections than nondiabetics.[66] Activation or inhibition of extraoral bitter or sweet taste is an inexpensive diagnostic tool and bitter taste stimulation can be an alternative to antibiotics.[67]
Different routes for administration of medicines and immunity
Medicinal intervention with multiple aspects, indicated in the second phase of jwara, has a multimodal action.
Niruha basti, rectal route, and immunity
Niruha basti (rectal route medication) is the second option after milk, indicated to ease fatigue and constipation. It stimulates agni, improves stamina and taste, diminishes jwara, and induces sweating.[68]
Rectally administered drug bypasses the first-pass metabolism and reaches the circulatory system with significantly less alteration and in greater concentrations (depending on the drug). Hence, rectally administratied medication has higher bioavailability and shorter peak, than oral administratied medication.[69] In addition, modulated immune responses have been observed after the course of Basti in obese individuals.[70]
Virechana nasya and advantages of the nasal route
Nasya is mainly indicated for headache, dysfunctioning of the sensory organs in jwara, anosmia, and dysgeusia.[71] It is classified as pradhamana nasya, the powder form, specified in acute conditions and loss of consciousness, while avapeeda nasya, the liquid form, removes congestion and alleviates the heaviness of the chest and head.[72] Tactless use of nasya can intensify the symptoms, augment vata, and distress sensory organs.
Nasal absorption of the drug is generally quicker and higher than gastrointestinal absorption and shows a blood concentration similar to that after intravenous administration. It is recognized as a very promising administration route for the systemic drug delivery of peptides and proteins.[73] Many studies have noted its effect on the central nervous system.[74,75] The live attenuated influenza vaccine FluMist (USA) or Fluenz (Europe) is delivered intranasally for the people between 2 and 49 years of age.
Anjana, ocular route, and immunity
Anjana (topical treatment of eye) and medicinal dhoopana (fumigation) are indicated for ExJ before the spike of the fever and JJ, in the absence of dosha disparity.[76]Anjana causes lacrimation and relieves inflammation, dull ache, and itching of eyes, principally used for kapha disorder.[77]Anjana was seen to be effective in preserving the vision in ulcerative keratitis and vernal kerato-conjunctivitis (spring catarrh).[78]
A healthy ocular surface microenvironment, especially a stable tear film, is essential to protect from environmental and microbial insults. The lacrimal gland secretion consists of various microbicidal proteins, which provides a healthy microenvironment to protect the ocular surface from invasive pathogens.[79]
Fumigation and disinfection
Fumigation with garlic peel, turmeric powder, ajwain seed powder, and loban has significantly improved the microbiological quality of air. Garlic peel fumigation is seen to be effective on surface disinfection, against a drug-resistant bacterium.[80,81]
Discussion
The timeline of phases and prognosis of jwara is depend on the invaded dosha, and on the type of antigen, in fever. If anorexia in fever is an alarming immune response, then appetite stimulation hypothetically indicates the stage of remittance, which is expected within 10 days of the onset of fever. Langhana, swedana, yavagu, warm water, and bitter taste diet induce sweating and are the nonpharmacological ways of thermoregulation of jwara. They have curative value in the first phase of jwara and safe if done according to the guidelines. The indications and contraindications of each treatment counterbalance the bala in the form of thermoregulation, protection, and nutrition. Similarly, the sweat-inhibiting function of tikta rasa restrains the total amount of sweat, however when blended with warm food and water, it regulates the thermal energy of the body. Langhana with red rice yavagu and processed warm water can be called functional food. The protein-rich food such as Yusha, milk, and meat soup with red rice may balance nitrogen in the second phase of jwara. Niruha basti and anjana are provincial protectors, while Pradhamana nasya stimulates the nervous system and dhoopana is an air purifier and a surface disinfectant. The current article has tried to provide the maximum pieces of evidence of immunomodulatory action of each part of jwara treatment, and the pyrogenic and antipyretic inclusive effects of nonpharmacological thermoregulatory management of jwara need further evidence to check its overall influence on the synthesis of cytokines and other immune cells.
Context of bala as immunity in jwara treatment
The term bala has been used invariably for the strength of mind, body, and the components of the body.[5] Various studies evaluated the concept of immunity through the role of bala, dosha, dhatu, agni, ojas, and season, and their balya action.[5,82–84] Strength of the disease, here jwara and strength of the host, can alter the dose of the medicine and the course of the treatment. Like in the first phase of EnJ, importance is given to the thermoregulation and in the second phase after remittance, to the physical strength contrast to ExJ. Anti-jwara treatment is a combination of multimodal treatments, such as phase-wise treatment and dietary modulation, specific tastes, thermoregulatory approaches, and different routes of administration of medicines, which have the function of providing strength, protection, nourishment, and stability to the other parts of the body to sustain bala of the host. The balya action of any nutrient or therapy differs according to the stage, and the type of the jwara is the significant feature of this treatment. For example, processed milk is indicated as lifesaving in the second phase, but noxious in the first phase.[85,86]
Anti-jwara treatment as immunity regulator
Every degree Fahrenheit rise in body temperature increases basal metabolic rate (BMR) by 7%. The various immune cells require several aspects for effective functioning besides increased energy demand and adequate and appropriate nutrition for all cells, including the cells in the immune system.[32] Dissipation of heat by anti-jwara treatment lowers the metabolic rate and the production of thermal energy to compensate for increased energy demand, different types of tastes trigger immune cells and also take care of adequate nutrition and prevents dehydration. The Balya action of jwara treatments can be categorized under three parts as those that can decrease the metabolic rate for the proper functioning of the immune system such as langhana, swedana, and yavagu; those that provide nutrition and strength such as red rice yavagu, yusha, meat soup, milk, and niruha basti to regulate innate immune responses; and those approaches that alleviate damage induced by dysregulated inflammatory responses such as tikta rasa, niruha basti, anjana, and nasya.
In the present pandemic scenario of coronavirus, the study is expected to aid the ongoing clinical studies. Clinical data to prove the overall impact of anti-jwara therapy on immune cells are insufficient. However, the separate shreds of evidence can give the extent of the efficacy. A daily practice of dhoopana, nasya, anjana, and jwara diet is an easy and inexpensive method that can be practiced individually for prevention.
Conclusion
Jwara treatment may enhance immunity through conserving energy at tissue levels and also by regulating the body temperature. Some of the treatment modalities such as langhana, bitter taste diet, niruha basti, anjana, and dhoopana directly impact the immune system. Nonpharmacological first-phase anti-jwara treatment protocol with other precautionary measures may limit the infection to the self-recovery mode.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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