According to the Madhava Nidana sutra, fever (jvara) arises due to dosha accumulation in which organ first?

• A. Liver
• B. Stomach
• C. Lungs
• D. Heart

Answer: (B)

The main idea is that fever starts from an imbalance rooted in the digestive region. In Madhava Nidana, the digestive fire (agni) in the stomach area (amashaya) is the first place where doshas accumulate when digestion is disturbed by factors like improper diet or environmental influences. This initial dosha aggregation in the stomach disrupts digestion, promotes ama formation, and initiates the vitiation of doshas that manifests as fever. From there, the imbalance can propagate to other parts of the body, but the initiating site is the stomach because it houses the central metabolic fire and is the first point where doshas collect and begin to express disease. The liver, lungs, and heart may be involved later in the disease process, but they are not the initial site of dosha accumulation described for jvara.