Fever, also known as pyrexia, is a common medical symptom as well as a sign that indicates an increase in internal body temperature to levels above normal. Fever results from a temporary elevation in the body’s thermoregulatory set-point, which is usually set at a normal temperature of 37o C (98.6o F). Body temperature varies with time of the day, with lower levels in the morning and higher levels in the evening.
Fever is present if oral temperature is over 37.2o C (98.96o F) in the morning and 37.7o C (99.86o F) in the evening, the corresponding rectal temperature (in anal canal) would be 0.4o C (0.72o F) higher. In addition to diurnal variations, body temperature is also influenced by age and gender (especially women in reproductive age group). Fever is not considered medically significant until body temperature is above 38° C (100.4° F). There are different accompanying symptoms of fever, which depend on its underlying causes. These include chills, rigors, malaise, arthralgia, anorexia, fatigue, dizziness, sweating, etc.
Fever serves as one of the body’s natural defense against microbes. For that reason, low fevers should normally go untreated, unless accompanied by troubling symptoms. Fever is termed as low grade if it is between 38o–39° C (100.4o–102.2° F), moderate if it ranges within 39o–40°C (102.2o –104.0° F) and high grade if it is over 40° C (104.0° F). Depending upon the course of fever, fever can be:
- (1) Continuous fever, if the temperature remains above normal throughout the day and does not fluctuate more than 1o C (1.8o F) in 24 hours; e.g. urinary tract infections, typhoid, lobar pneumonia.
- (2) Intermittent fever, if fever touches base line for several hours of the day. If the spike occurs every day it is quotidian, spike every alternate day is called tertian and if this occurs after every third day then it is quartan intermittent fever; e.g. malaria.
- (3) Remittent fever, if the temperature remains above normal throughout the day with fluctuations of more than 1 degree Celsius; e.g. infective endocarditis.
- (4) Irregular fever if the pattern does not fit into any of the patterns indicated above.
Causes of fever
- (1) Infectious diseases: viral infections, malaria, influenza, sore throat, typhoid, pneumonia, measles, chickenpox, tuberculosis.
- (2) Tissue injury.
- (3) Cancers of liver, kidney, lymph nodes.
- (4) Immuno-inflammatory diseases such as systemic lupus erythematosus, vasculitis.
- (5) Drugs and toxins.
- (6) Exposure to high environmental temperature.
- (7) Fever of unknown cause.
The main risk of moderate to high fever is dehydration. Patients with fever need more fluids than usual. Body temperature greater than 41.67o C (107o F), can result in brain damage and possibly death. Whatever may be the cause, uncomplicated mild to moderate fever can be managed with a simple herbal preparation mentioned in Ayurvedic classics such as Kiratatikta.
Kiratatikta [Swertia chirata (Roxb. ex Fleming) H. Karst]
Kiratatikta powder consists of dried, matured pieces of whole plant of Swertia chirata (Roxb. ex Fleming) H. Karst, an erect, annual, herbaceous plant. It is about 0.6-1.25 metres high, found in temperate Himalayas at an altitude of between 1200-3000 metres from Kashmir to Bhutan and Khasia Hills in Meghalaya. The plant is collected when it flowers during July to October and dried in the shade. The formulation is mentioned in classical Ayurvedic texts, Ayurvedic Pharmacopoeia and Ayurvedic Formulary of India for various types of fever.
The formulation is a powder made from dried, matured pieces of whole plant of Swertia chirata.
|English name||Chiretta, Chirata, Brown chiretta, white chiretta|
|Latin name||Swertia chirata (Roxb. ex Fleming) H. Karst|
|Part used||Whole plant|
Main chemical constituents
Xanthones, xanthone glycoside and mangiferine (flavonoid).
|Foreign matter||Not more than 2%|
|Total ash||Not more than 6%|
|Acid insoluble ash||Not more than 1%|
|Alcohol (60%) soluble extractive||Not less than 10%|
|Water-soluble extractive||Not less than 10%|
Method of preparation
Take dried whole plant of Kiratatikta and further dry it in the shade to remove moisture for easy powdering or making coarse powder for decoction.
- (1) Grind the material in a grinder or pulverizer until fine powder or coarse powder is obtained.
- (2) For obtaining the fine powder filter it through mesh size 85. Coarse powder is used as such for decoction, there is no need to filter it.
- (3) The shelf life of the powder is four months but it can retain its potency if kept in an air-tight container and protected from direct sunlight and heat.
Dark-brownish bitter powder or warm, dark brownish bitter liquid.
Anti-pyretic, anti-malarial, anthelmintic, anti-leishminial, antiinflammatory, anti-tubercular, cholagogue, hepatoprotective, antidiabetic, laxative, stomachic, tonic.
Dose and mode of administration
The dose of Kiratatikta powder for adults is 1-3 grams and for children it is 250 mg to 500 mg, with water. The dose of decoction for adults is 25-30 ml and for children, it is 5 ml to 10 ml, to be taken twice a day after meals.
Indications and uses
Fevers of known and unknown causes.
Precautions and safety aspects
- (1) Although no toxic effects are reported with Kiratatikta, the patient taking oral hypoglycemic drugs should take the medicine under medical supervision as Kiratatikta may interact with oral hypoglycemic drugs potentiating its hypoglycaemic action.
- (2) Medication with Kiratatikta should be stopped, if the intensity of fever does not decrease within a few hours and the symptoms aggravate. Chronic and severely feverish patients should consume Kiratatikta under medical supervision.
- (3) Pregnant women should take this medication under medical supervision. However, it is safe for the baby if the nursing mother is taking this medication.
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- (2) Billore KV et al. Database on Medicinal Plants Used in Ayurveda, Vol. 7. New Delhi: Central Council for Research in Ayurveda and Siddha, 2005. p. 227, 229.
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- (4) Grover J, Yadav S, Vats V. Medicinal plants of India with anti-diabetic potential. J. Ethnopharmacol. 2002.
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- (6) Sabnis Mukund. Chemistry & pharmacology of Ayurvedic medicinal plants. Varanasi: Chaukhambha Amar Bharati Prakashana, 2006.
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- (8) National Institute of Science Communication and Information Resources, The useful plants of India. New Delhi: Council of Scientific and Industrial Research, 2000.
Source: Traditional Herbal Remedies for Primary Health Care - WHO