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Astanga Hrudaya

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द्विधा कफेन जङ्घाभ्यां स पूर्वं शिरसोऽनिलात् । अस्थिमज्जोभयगते चतुर्थकविपर्ययः ॥ ७३ ॥

viz, with the predominance of kapha, the symptoms commencing in the calves first and with the predominance of vata, symptoms commencing in the head first. Doshas residing in both the asthi (bone) and majja (marrow) simultaneous produce chaturthaka viparyaya jvara,

english translation