hyperpyrexia along with ayurvedic management

1. HYPERPYREXIA
PRESENTED BY
DR.RADHA JOSHI
M.D SCHOLAR KAYA CHIKITSA

2. INTRODUCTION
Pyrexia or fever is the rise in body temperature above the normal
level with upward set shift in thermoregulatory set point.

3. • Pyrexia –greek- pyr meaning fire.
• Febrile- latin- febris meaning fever.

4. Normal Temperature Regulation In Body
• Normally heat is continuously produced in
body and being lost to surroundings.
• Rate of heat production= Rate of heat loss,
person is said to be in heat balance.
• When there is disturbance of equilibrium between the
two, then body temperature may rise-fever or fall-
hypothermia.

5. • At 6 am 37.0 C (98.6 ° F)
• At 6 pm 37.6 C (99.6 ° F)- Increased BMR & Muscle activity.
• An a.m. temperature of >37.2°C (>98.9°F)
• An p.m. temperature of >37.7°C (>99.9°F) defines a fever

6. • Normal diurnal variation - 1 ° F
• Temperature:- Rectal > Oral > Axillary

7. Fever:- is an elevation of body temperature above normal
circadian variation as a result of change in
thermoregulatory centre, located in anterior hypothalamus.
Maximum body temperature is found in the evening
hours at the 4 p.m it is 990 F
Minimum body temperature is found at 6 a.m it is 98.020
F

8. • Relation with Pulse, Resp., BMR
with every 1° F rise of temp i.e >100 ° F
Pulse Rate increases 10
Respiratory Rate by 4
BMR by 7
Oxygen consumption increases by 13%

9. STAGES OF FEVER
4 Successive Stages –
• 1.Prodrome:- Non-specific complaints
Mild headache
Fatigue
General Malaise
Aches and Pains
• 2.Temperature rises:- Generalized shaking with chills and
feeling of being cold
Vasoconstriction
Piloerection precede onset of shivering
Skin is pale

10. • 3. Flush:- Cutaneous vasodilation occurs
Skin becomes warm
Flushed
• 4. Defervescence:- Initiation of sweating

12. PATHOGENESIS OF FEVER
TOXINS
TUMOURS
MICROBIAL
AGENTS TRAUMA
ACTIVATION OF INFLAMMATORY CELLS CAUSING RELEASE OF
VARIOUS CHEMICAL MEDIATORS LIKE-IL-2,6,8 TNF- alfa, beta,
gamma
Cells are known as pyrogens
INFLAMMATION

13. Concentration of pyrogens increases in the blood plasma
Increase concentration of pyrogens in blood causes excessive
synthesis of PGE 2 in hypothalamus
It causes increase the concentration of cyclic amp in
hypothalamus
It causes the upward set of thermoregulatory set point, which
sent the signal to different part of the body for heat
conservation and leading in rise to body temp k/a Pyrexia

15. OTHER TYPES OF FEVER
Pel-Ebestin Fever:-In this rising body temp. is seen on
continuous basis for 7-12 days and then pt. remains afebrile
continuously and again come for the same duration.
Ex –Hodgkin's and Non Hodgkin's Lymphoma
Other Hematological Malignancy
Step Ladder Pattern:-It is seen salmonella infection which causes
typhoid fever .
In this gradual rising body temp. is seen over a period of days
and attain its maximum value forward by gradual decrease in
body temp. over a period of days.

16. Black Water Fever:- It is seen in cases of complicated malaria
caused by plasmodium falciparum in this excessive intra
vascular hemolysis takes place causes hemoglobinemia due to
hemoglobinemia urine becomes brownish black.
Differential Diagnosis with chills and rigor:-
-Malaria
-UTI
-Pneumonia
-Filariasis
-Kala azar
-Septicemia

17. Causes of fever with skin eruption:-
Chicken pox
Measles
Dengue
Typhoid fever (red spot)
Rubella infection
German measles
Herpes zoster

18. HYPERPYREXIA
Body temp. begins to rise and may reach level (41-42 0C)
Two broad types of Hyperthermia are recognized.
1-External hyperthermia- may occurs sporadically in
healthy young individual engaged in strenuous and
prolonged physical activity, especially in hot weather e.g
marathon runner
2-Classic hyperthermia-can result from a large number of
conditions.

19. CAUSES …
Disorder of excessive heat production
1 Heat stroke
2 Drug induced hyperthermia
3 Neuroleptic malignant syndrome
4 Serotonin syndrome
5 Malignant hyperthermia
6 Endocrinopathy
7 Central nervous system damage
8 Thyrotoxicosis

20. Disorder Of Decreased Heat Dissipation
1 Occlusive dressings
2 Autonomic dysfunction
3 Anticholinergics
4 Neuroleptic malignant syndrome

21. Disorder of Hypothalamic Functions
1-NMS
2-CVS
3-Encephalitis
4-Meningitis
5-Cerebral Malaria
6-Trauma

22. Clinical Features
1- High temperature
2- Dry skin
3- Cerebral dysfunction
4- Headache ,vertigo , abdominal discomfort
5- Hallucinations
6- Delirium
7- Pupil dilation
8- Muscle rigidity
9- Elevated level of creatinine phosphokinase

23. In More Severe Cases
1-Delirium
2-Convulsions
3-Rapid loss of consciousness
4-Focal neurological signs are unusual
5-Occasionally, bleeding tendency
6-Death may occurs in few hours due to ARF,
peripheral circulatory failure or multiple organ
failure

24. INVESTIGATIONS
• CBC
• ESR
• WIDAL TEST
• M.P. TEST
• NS 1 TEST

25. MANAGEMENT
The immediate goal of treatment should be rapid
cooling of the body (with in one hour)
 The aim should be achieve a core temperature of 390
C/1020 F

26.  FOR UNSTABLE PATIENTS
A - AIRWAY CONTROL
B - BREATHING
C - CIRCULATORY SUPPORT
 Initate broad spectrum - antibiotic treatment
immediately for immunocomprised patients
and patients with unstable vital signs or
profound mental status changes.

27. MEASURES TO REDUCE BODY
TEMPERATURE
 A physical measure-physical cooling is the main stay of
treatment
 Immersion in ice water bath is quickest way to reduce the
temp.
 A conventional method is “evaporative cooling” which
involves moving the patient to the nearest cool place, under
a revolving fan and removing most of the clothing
 The body should be placed in the lateral decubitus position
 Loosely wrapped in a cool wet sheet and frequently
sprinkled cold water

28. CONT….
Ice packs should be applied over the head and
limbs
Such measures should be continued until the rectal
temp drops to 390 c
Advanced techniques to reduce core temp are
based on
“intravascular heat exchange” principle and
involves either haemodialysis or heat exchange
catheters.

29. TREATMENT
• The attempt to lower the already normal hypothalamic set point of
little use.
• Physical cooling with sponging, fans, cooling blankets and even
ice bath should be initiated immediately in conjunction with the
administration of i/v fluid and appropriate pharmacological
agents.
• If sufficient cooling is achieved by external means , internal
cooling can be achieved by gastric or peritoneal lavage with iced
saline.
• In extreme circumstances, hemodialysis or even cardiopulmonary
bypass with cooling of blood may be performed.

30. • Antipyretics drugs – PCM, Acetaminophen
• Chlorpromazine – 500mg i/v
• Diazepam – 5 mg i/v
• Restlessness, Convulsions, Shivering will be controlled
with these drugs.
• Corticosteroids also recommended
• Oxygen also recommended
• NSAIDS should be given
• Salicylates also given

31. ज्वर
प्रमुख संदर्भ ग्रन्थ
१.चरक निदाि –अध्याय १
२.चरक नचनकत्सा –अध्याय ३
३.सुश्रुत उत्तर तन्त्र-अध्याय ३९
४.अष्टाड.हृदय निदाि –अध्याय २
५.अष्टाड.हृदय नचनकत्सा-अध्याय १
६.माधव निदाि (प्रथम खण्ड)-अध्याय २
७.र्ावप्रकाश-अध्याय ४

32. • ज्वर की निरुक्ति:- ज्वरनत ज्वरणं वा |
• प्रक
ृ नि:- दोषााः शारीरमािसााः |
• स्वभाव रूप प्रक
ृ नि:- क्षयस्तमो ज्वर पाप्मा मृत्युश्चोक्ता
यमात्मकााः |
• प्रवृनि:- पररग्रहात्
रूद्र कोपात् दारुणात्

33. ज्वर का प्रर्ाव
“संिाप: सारुनिस्तृष्णा िाङ्ग् मर्दो हृर्दय व्यथा |
ज्वरप्रभावो जन्मार्दौ निधिे ि महिंमः ||” (ि.नि.३/२६)
निर्दाि:- ऋत्वहोरात्रर्दोषाणाम् मिश्च बलाबलाि् |
कालमथथवशाश्चैव ज्वरस्तं िं प्रपद्यिे ||
(ि.नि.३/७५)
वषाभनद ऋतु, नदि-रात, दोष और मि क
े बलवाि होिे से या
दुबभल होिे से तथा पूवभजन्मक
ृ त कमभ क
े कारण संतत आनद
ज्वर नर्न्न- नर्न्न अपिे काल पर हुआ करते है |

34. प्रत्यात्म लक्षणं:- संिापो र्देहमािसः |
पूवथरुप:-
आलस्यं ियिे सास्रे जृम्भणं गौरवं क्लमः |
ज्वलिािपवाय्यम्बुभक्तिद्वेषावनिनशििौ ||
अनवपाकास्यवैरस्ये बलवणथयोः |
शीलवैक
ृ िमल्पं ि ज्वरलक्षणं अग्रजम् ||
(ि.नि.२८/२९)

35. (BHEDA) TYPES
Dividha bheda in 5 pairs:-
(a) Sharirika
Mansika
(b) Soumya
Aagneya
(c) Antravega
Bhiravega
(d) Prakrita
Vakrita
(e) Sadhya
asadhya

36. • According to kala bheda:- 5 types
Santata
Satata
Anyedhushaka
Tritiyaka
chaturathaka
According to aashrya bheda:- 7 types
Rasagata
Raktagata
Mansagata
Medogata
Asthigata
Majjagata
shukragata

37. Dvividha bheda:-2 types
Nija jwara:-8 types aagantuja jwara:-4 types
Vataja abhighataja
Pittaja abhishapaja
Kaphaja abhicharaja
Vata-pittaja abhishangaja
Vata-kaphaja
Pitta-kaphaja
Sannipataja
aagantuja

38. संप्राप्ति चक्र
निदाि सेवि+नमथ्या आहार नवहार
निदोष प्रकोप
आमाशय में दोषो का संचय
प्रक
ु नपत दोषो का रस धातु से संयोग
प्रक
ु नपत दोषो एवं रस धातु का सवभशरीर मे फ़
ै लिा

39. कोष्ठ अनि का अपिे आशय से बनहगभमि
साम दोषो क
े द्वारा स्वेदवह श्रोतो मे अवरोध
संपूणभ शरीर का उष्ण होिा
ज्वरोत्पनत्त

40. संप्राप्ति घटक
दोष - निदोष, नपत प्रधाि
दू ष्य - रस धातु एवं कोष्ठानि
स्रोतस - रसवह
अनधष्ठाि - आमाशय
स्त्रोतोदुनष्ट - संग
स्वर्ाव - आशुकारी
अनिदुनष्ट - अनिमांद्य
साध्यासाध्यता - साध्य

41. अनििीव्र ज्वर वेग का वणथि
१.बनहवेग ज्वर
२.पच्यमाि ज्वर
३.पैनत्तक ज्वर
४.अनर्न्यास ज्वर
५.नवषम ज्वर
अ.मलेररया
ब.कालाजार
स.मन्थर ज्वर
द.श्वसिक ज्वर
क.ग्रंनथक ज्वर
ख.कणभमूनलक ज्वर
ग.रोमाप्तिका

42. नचनकत्सा सूि
According to charak :-
लंघिम् स्वेदिम् कालो यवाग्वप्तस्तक्तो रसाः |
पाचिान्यनवपक्वािाम् दोषाणां तरुणे ज्वराः ||(च.नच.३/१४२)
According to bhavaprakash
ज्वरादौ लंघ्नम् प्रोक्तं ज्वरमध्ये तु पाचिं |
ज्वरांते र्ेषजं दद्याज्ज्वरमुक्ते नवरेचिं ||
Nav jwara tyajya 9 things:-
िवज्वरे नदवास्वप्नस्नािाभ्यंगान्नमैथुिम् |
क्रोधप्रवातव्यायामाि् कषायाश्च नववजभयेत् || (च. नच.३/१३८)

43. Shadhangpaniya
मुस्तपपभटकोशीरचन्दिोदीच्यिागरैाः |
श्रृतशीतं जलं दद्यात् नपपासाज्वरशािये || (च.नच.३१४५)
Sannipataja jwara
वधभिेिैकदोषस्य क्षपणेिोप्तितस्य वा |
कफस्थािािुपूव्याभ वा सनन्नपातज्वरं जयेत् || (च.नच.३२८६)

44. संशमि नचनकत्सा
रस/भस्म/नपष्टी
मािा १२५-२५०mg
अिुपाि उष्ण जल मधु
निर्ुविकीनतभ रस
लक्ष्मीनवलास रस
मृत्युंजय रस
कस्तूरीर्ैरव रस
कफक
े तु रस
स्वणभ बसंत मानलिी रस
प्रवाल नपष्टी
जयमंगल रस
नहन्गुलेशवर रस

45. वटी
मािा २५०-५००mg
अिुपाि उष्ण जल
संजीविी वटी - 250mg
संशमिी वटी - 250mg
सुदशंिघि वटी - 250mg
नवषनतन्दुकानद वटी - 250mg
अमृता सत्व - 500mg
चूणभ
मािा ३-६ gm
अिुपाि जल/शहद
सुदशभि चूणभ
पंचकोल चूणभ

46. नसतोपलानद चूणभ
तानलशानद चूणभ
क्वाथ/आसव/अररष्ट
मािा ४०ml
अिुपाि जल
िागरमोथा + पपभट क्वाथ
सोंठ + पपभट
धमासा + पपभट
नचरायता + गुड
ू ची + मोथा + पपभट
पाठा , खश , सुगंधबाला
पटोल पंचक क्वाथ
गुड
ू च्यानद क्वाथ
अमृताररष्ट

47. घृत तैल
मािा २०-३०ml
अिुपाि उष्ण जल
पंचनतक्त घृत
अमृतानद घृत
चंदिानद घृत
षटपल घृत
अवलेह
मािा १०-२०gm
अिुपाि दू ध
द्राक्षावलेह
च्यविप्राश

48. व्यवस्था पि
१ निर्ुविकीनतभ रस - १२५नम ग्रा
गोदिी र्स्म - २५०नम ग्रा
टंकण र्स्म - २५०नम ग्रा
मधु से १-२ मािा (सुबह – शाम)
२ सुदशभि चूणभ – ३ gm २ बार
३ संजीविी वटी -– 2 tab २ बार
४ नकरानतक्तानद क्वाथ - ४० नम ली
सम र्ाग जल से २ बार
५ हरीतकी चूणभ - ३ gm
१ मािा रात में सोिे से पहले

49. PATHYA APATHYA
• Purana Shali, Mudga, Masur, Guduchi, Jiwanti, Parwal, Karela
• Anar, Munakka, Seva, Papita, Dalia, Laghu, Aahar
• Yavagu, Yava, Peya, Vilepi
• Langhana, Vishrama
APATHYA
• Guru, Vidahi, Vishtambhi Anna (dadhi)
• Dushita Jala
• Pizza burger, Samosa, Kachori should be avoided
• Exercise, Vega dharana, Adhyashana, Diwaswapa
• Snana, Maithuna, Kshaya rasa, Krodha also avoided

50. THANK YOU