By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Langhana means treatments which bring about lightness in the body. It forms the first line of treatment in fevers, in acute fever i.e taruna jwara to be precise.
‘Anything which brings about lightness in the body is called as langhana’.
Taruna Jwara – translates to young fever. This implicates to the fever in its initial days of manifestation. Fever for the first 7 days is called as taruna jwara. This term can also be used to explain the acute fevers.
Read – Langhana Therapy – A Unique Ayurvedic Treatment Principle
Why should Langhana be administered in Fever?
Pathogenesis of fever as explained in Madhava Nidana treatise –
‘In persons consuming incompatible and unwholesome foods and activities, the doshas get vitiated and get lodged in the stomach. These doshas then throw out the gut fire (weaken the digestive fire) and cause fever travelling through the rasa carrying channels’.
Read – Rasa Dhatu: Definition, Formation, Circulation, Imbalance Diseases, Treatment
According to this reference the site of origin of fever is stomach (and intestine).
And for all those diseases taking their origin from the stomach Langhana – fasting is the first medicine. Therefore Langhana is an important therapeutic strategy in the treatment of fevers.
Langhana – the first line of treatment in fever
Langhana should be the first line of treatment once the fever gets manifested.
Langhana should not be administered in fevers caused by –
- Depletion of tissues – kshaya
- Vata – Anila
- Fear – Bhaya
- Anger – Krodha
- Desire, lust -Kama
- Grief – Shoka
- Exhaustion -Shrama
Some have opined to take kshaya and anila together. This forms kshayanila. This means ‘in fevers caused by vata aggravated due to the depletion of tissues’.
Read – Decrease Of Tissues – Dhatu Kshaya – Reasoning, Symptoms
- Manasa Jwara – fevers caused by mental imbalance (Sushruta)
- Urdhwa Maruta – Vata having upward course of movement
- In presence of thirst
- In presence of hunger
- In presence of mouth dryness
- Pregnant woman
- Old aged
- Debilitated persons
- Fearful persons
Extra contraindications mentioned by Master Vagbhata (A.Hr.Chi.1)
Contra indication in fevers caused by desire, grief etc?
In each of the above enlisted condition contraindicated for fasting, there will definitely be association of vata over a period of time. Therefore if fasting is done in fever caused by these factors it will further vitiate vata and cause complications and hence should not be advocated.
Before knowing which type of langhana should be used and in what way, we need to first check upon the types of langhana.
Types of Langhana
There are 10 types of lightening therapies, as mentioned below –
- Decoction enema
- Head cleansing through nasal drops
- Withholding the urge of thirst
- Exposure to wind
- Exposure to sunlight
- Ama digesting medicines
Should all types of Langhana be administered in Fever?
Master Chakrapani clarifies this doubt by telling that ‘in treatment of fever, langhana means anashana or upavasa’. This means to tell that in acute fevers the treatment should be started with ‘fasting’. This also means that the other forms of lightening therapies should not be administered during the first 6-7 days of fever.
Read – How To Do Fasting? A Step By Step Guide For You
What about other forms of Langhana?
The four types of shodhana i.e. purifying measures included in langhana – emesis, purgation, decoction enema and head cleansing are administered in fever but not in acute fevers. Since they are administered conditionally as and when needed, they are not desired in the initial stages of fever.
Exposure to wind and exercise are as such contraindicated in newly manifested fever.
Since use of hot or cold water and medicated water are advised in fever as per the condition of fever and dosha involved, withholding the urge for thirst is not an option in acute fevers.
Since all fevers are associated to variable amounts of temperature differences exposure to the sun is contraindicated.
Pachana is explained as a treatment strategy in later conditions of fever and should be done after langhana.
So, among the 10 forms of langhana only fasting is left over and that alone should be administered at the beginning of the fever, as initial intervention.
But therapeutic emesis has been explained in taruna jwara…?
In the context of prescribing yavagu i.e. different kinds of gruels for patients of fever, master Charaka tells that ‘Gruels should be administered in proper time to a patient who has undergone emesis and fasting’.
This is one of the treatment principles in acute fevers. But we already have seen that apart from fasting no other forms of langhana, including emesis (which is a type of langhana as already mentioned) should be administered in the first 6-7 days of fever.
But in this verse the chronology puts fasting after emesis making emesis as the first choice treatment in the treatment of taruna fevers.
Before deciding if emesis is the first line of treatment in acute fevers, let us see the conditions in which emesis should be administered in taruna fevers?
Emesis should be administered in a patient suffering from acute fever only when the below mentioned conditions are available –
- Predominant vitiation of kapha in the stomach
- Doshas (kapha predominant doshas) showing signs of preparedness of getting expelled out i.e. signs of excitation like nausea etc
- Doshas should have been located in the stomach
The physician having considered these doshas as causal for acute fever should administer emesis to the eligible patients in proper time, using proper and comprehensive emetic formulations. After emesis, fasting should be started. If there are no signs of kapha aggravation or excitation treatment should be started with fasting.
Master Harita too tells – ‘Emesis should be administered at the beginning to expel morbid pitta and kapha’.
Here ‘at the beginning’ does not imply to ‘at the beginning of fever’. It is conditional. Emesis should be administered at the beginning of pitta and kapha type of fevers, that too if there is severe exacerbation of these doshas. This rule is not applicable to all kinds of fevers.
Therefore langhana itself stays as the prime treatment strategy in fevers.
Read – Ayurveda Lifestyle and Diet For Fever – 45 Important Things To Know
Langhana or Vamana – Which is the first choice in treatment of acute fevers?
Without any doubt fasting is the first choice of treatment during the first 6-7 days of fever. Administering emesis is conditional.
Rule 1 – The earlier stages of fever are associated with symptoms of ama. The doshas causing fever too are associated with ama. In such conditions the treatment should be initiated with lightening therapies in the form of fasting (to one’s capacity). The other condition for starting the treatment with fasting is ‘absence of kapha aggravation or presence of excited kapha in the stomach’. Here fasting forms the first line of treatment for acute fevers.
Rule 2 – There is every chance that kapha predominant symptoms as evidenced by the presence of ‘signs of eligibility for emesis in fever’ as highlighted above are present right at the beginning of the fever. This is also true because stomach is the origin for both fevers and kapha. In such condition advising the patient to fast or starve will not help. This is because of presence of abundance of kapha predominant doshas in an excited state waiting to be expelled from the stomach. Here if you administer fasting it might not be sufficient to expel the aggravated kapha.
As a rule, when doshas are present in excess, lightening therapies should be given in the form of purifying therapies, emesis in this context.
Once the kapha has been expelled we can come back to the principles of treating acute fevers and advise ‘fasting’ as the immediate next measure. Fasting – further helps to dry off the kapha which has not been expelled through emesis. Here the treatment starts with emesis and continues with fasting. This justifies the statement made by Charaka in the context of ‘administration of yavagu’.
As per master Harita, emesis can be the first hand treatment in kapha predominant and pitta predominant fevers.
Pachana should be given first in fevers?
In Charaka Sutra Sthana section, Chapter 22, verses 20-21, Master Charaka enlists some diseases having moderate strength in which Pachana should be administered as ‘first line of intervention’. Fever is also counted among them. According to this reference, Pachana should be given first in treatment of fever. In the Chikitsa Sthana, Charaka tells that Langhana should be given as ‘first line of intervention’. These two references create confusion and are mutually contradictory.
Master Chakrapani gives clarification for this and tells –
‘Pachana should be administered before starting the medicines (applies to the reference quoted in Sutra Sthana) but not at the beginning of fever’.
This sums up into the below mentioned conclusions –
- At the beginning of fever (initial days of acute fever) – langhana (fasting) should be administered
- At the beginning of medicines (prior to administration of oral medicines) – pachana should be administered
Therefore the reference from Sutra Sthana will not be applied in this context.
Read – When To Stop Fasting? Warning Symptoms To Watch
Langhana shall be administered in fevers caused by Margavaranajanya Vata
We have seen that fasting should not be administered in case of vataja type of fevers. Fasting should not be administered in ‘Nirama Vata’ condition i.e. wherein vata is not associated with ama.
Vata aggravates due to two reasons –
1. Dhatu Kshaya i.e. depletion of tissues –
As discussed earlier when fever is caused by vata aggravated due to depletion of tissues, then fasting should not be advised.
2. Margasya Avarana i.e. obstruction to the movement of vata caused by enveloping of vata –
Master Chakrapani tells that in ‘fevers caused by vata aggravated due to its passage routes being blocked’ langhana – fasting shall be given. Since the vata is aggravated due to it being enveloped by other dosha or vata subtype itself, the pathology is similar to vata being associated with vata (the enveloping material by nature acting like ama). Since this condition is similar to sama vata i.e. vata associated with ama, fevers caused by such enveloped vata are eligible for ‘fasting as langhana’.
Read – Mechanism Of Avarana, Types, Importance of Vata
Langhana in Sama Vata
Langhana – fasting also needs to be administered in sama vata or fevers caused by vata associated with ama.
Master Chakrapani further states – ‘in fevers caused by vata associated with ama, langhana can be skillfully given for the digestion of ama, but not as aggressively as in kaphaja type of fever’.
Kapha and ama are said to possess similar properties and are also similar in nature. In fevers caused due to kapha, if kapha is severely aggravated and excited, emesis should be administered followed by fasting. But if kapha is not severely aggravated and not excited, only langhana should be administered that too intensively. Contrary to this, in fever caused by sama vata intensive fasting as given in kapha type of fever should not be given because once the ama is destroyed, intensive fasting will aggravated vata. So in fevers caused by sama-vata fasting should be judiciously administered.
Read – Sama and Nirama Vata: Association of Ama With Morbid Vata
Can Langhana be administered in Jirna Jwara?
Jirna Jwara is a status of fever wherein it has surpassed the acute stage (taruna jwara). Jirna means digestion or digested. The fever is called so because the ama associated with the doshas in the earlier days of fever have been digested and the doshas are free of ama in this stage.
Fasting as a rule should only be administered in taruna jwara when there is association of ama. In Jirna Jwara fasting is strictly contraindicated due to the absence of association of ama.
Master Vagbhata further clarifies this principle telling – ‘Langhana should not be administered in fevers caused by only vata (not associated with ama), tissue depletion and in jirna jwara. In these conditions shamana i.e. palliative treatments which do not cause emaciation should be done’.
Can light food be given in acute fevers?
In Charaka Nidana Sthana section, Master Charaka tells that in fevers either light food or fasting should be advised. Master Chakrapani clarifies this by telling that light food should be given only in the premonitory stage of fever when fever has not yet been manifested. But once the fever has been manifested fasting alone is desirable. Therefore even light food is contraindicated in taruna jwara.
The only form of food that the person receives during acute fevers is yavagu i.e. different kinds of gruels. Even here gruels are not given as food, they are given as dietetic supplements to provide energy and support life for those who are fasting and also with an intention of digesting the ama associated with doshas (therapeutic action). Gruels are prepared with antipyretic herbs. Therefore gruels are not counted as food.
Read – Yavagu – Preparation, Benefits, Uses In Fever
Benefits of Langhana
- Dosha kshaya – depletion of the fever causing doshas (and ama)
- Sandhukshite anale – as a consequence of this, the digestive fire gets kindled
- Vijwaratvam – fever gets subsided
- Laghutvam – lightness is experienced in the body
- Kshudha – the person starts feeling hungry and becomes desirous of food
Limitations of Langhana
The physician should know the limitations of administering fasting therapy. The fasting should be planned in such a way that it doesn’t interfere with life and life activities. Health is abode of strength and energy and treatment is done only to establish a healthy condition in the body and not to pose threat to the life.
Fasting should be administered to a patient of fever until the doshas are obstructed and are moist and motionless.
In a person in whom the doshas have been obstructed, apatarpana i.e. fasting should be advocated after having considered the status of dosha and life in order to pacify the aggravation of doshas.
Langhana as Pachana
Langhana has a dual role. Apart from causing lightness in the body it also acts like Pachana i.e. an effective ama-destroying measure. Therefore Langhana is also extended into the next schedule of the treatment but in the form of one of the kinds of Pachana.