Changes

<li style="font-weight:bold">Seasonal diseases: <span style="font-weight:normal">The discussion was held in the months of spring and summer seasons (gharma maasa i.e. in the jyestha and aashadha maasa vis a vis vasanta and greeshma ritu). This evidence suggests that there was a possibility of outbreak of some kind of communicable disease in that particular time and season in the described region.These seasons are homologous to spring and summer season which even in the present era witness the outbreak of various exanthemata’s, allergic conditions and different type of fever annually.<ref name="ref39">Martinez ME. The calendar of epidemics: Seasonal cycles of infectious diseases. PLOS Pathogens. 2018 Nov 8;14(11):e1007327</ref></span></li>

<li style="font-weight:bold">Seasonal diseases: <span style="font-weight:normal">The discussion was held in the months of spring and summer seasons (gharma maasa i.e. in the jyestha and aashadha maasa vis a vis vasanta and greeshma ritu). This evidence suggests that there was a possibility of outbreak of some kind of communicable disease in that particular time and season in the described region.These seasons are homologous to spring and summer season which even in the present era witness the outbreak of various exanthemata’s, allergic conditions and different type of fever annually.<ref name="ref39">Martinez ME. The calendar of epidemics: Seasonal cycles of infectious diseases. PLOS Pathogens. 2018 Nov 8;14(11):e1007327</ref></span></li>

<li style="font-weight:bold">Epidemiological triad: <span style="font-weight:normal">Causative factors of janapadodhvansa can be compared to epidemiological triad which involves the external agent, susceptible host and environment. Interaction of these three components always leads to disease causation in large population and can be applied to both communicable and non-communicable diseases.<ref name="ref40">Principles of Epidemiology | Lesson 1 - Section 8 [Internet]. 2019 [cited 2020 Apr 9]. Available from: https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section8.html</ref> The concept of janapadodhvansa is similar to that of epidemic or pandemic, where epidemic is a condition affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time.<ref name="ref41">Definition of EPIDEMIC [Internet]. [cited 2020 Apr 4]. Available from: https://www.merriam-webster.com/dictionary/epidemic</ref> Pandemic is the condition occurring over a wide geographic area and affecting an exceptionally high proportion of the population.<ref name="ref42">Definition of PANDEMIC [Internet]. [cited 2020 Apr 4]. Available from: https://www.merriam-webster.com/dictionary/pandemic</ref> According to epidemiology, the causative factors affecting the contraction of disease  in population are similar to those mentioned in the chapter which includes geographic location (desha), climatic factors, biotic biological factors represented by plant related and zoological factors (vriksha (flora), mriga- pakshi (fauna)etc.) and abiotic or socioeconomic factors (janapada). The seasonality of diseases is important factor for the epidemicoutbursts throughout the globe.<ref name="ref43">Components of the Triad | Models and Mechanisms of Public Health [Internet]. [cited 2020 Apr 4]. Available from: https://courses.lumenlearning.com/suny-buffalo-environmentalhealth/chapter/components-of-the-triad/</ref> The kala factor does play an important role in disease manifestation. Deshaas mentioned earlier is important while considering the epidemiology, as outbreak of some diseases are region specific and their spread or progression also depends on the geographical, demographical and climatic conditions. It is helpful to understand the prevalence and incidence of diseases in the particular area. <br/>The description of vitiated air (vishama or vikrita vayu ) indicates climate change that increases the vulnerability of the populations to climate sensitive health risks like injury, mortality, temperature related illness (both hyperthermia and hypothermia), respiratory illnesses, zoonosis, vector borne diseases, malnutrition, communicable diseases, mental and psychosocial health etc.<ref name="ref44">Climate change and health [Internet]. [cited 2022 Jan 19]. Available from: https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health</ref> Both atichala and atikundalinam vayu can be understood as fast blowing winds, cyclones, hurricanes or tornados that can result in public health emergencies like storm related mortality, injury, infectious diseases, impairment of mental wellbeing due to socio-economic factors like displacement, unemployment, disruption of ecosystems etc.<ref name="ref45">James M. Shultz, Jill Russell, Zelde Espinel, Epidemiology of Tropical Cyclones: The Dynamics of Disaster, Disease, and Development, Epidemiologic Reviews, Volume 27, Issue 1, July 2005, Pages 21–35, https://doi.org/10.1093/epirev/mxi011</ref> Atiparusha vayu or overly dry air indicates lack of humidity or excessive dryness in air contributing to the physical health related symptoms like dry eyes, itching of skin, dry throat etc. The stress on the nasal mucosa to humidify the entering air is intensified leading to be a major cause of respiratory disorders.<ref name="ref46">Wolkoff P. Indoor air humidity, air quality, and health – An overview. International Journal of Hygiene and Environmental Health. 2018 Apr 1;221(3):376–90.</ref> Atisheeta vayu or excessive cold air like that in air conditioned environments also poses a threat to increase in respiratory infections.<ref name="ref47">Hyrkäs-Palmu H, Ikäheimo TM, Laatikainen T, Jousilahti P, Jaakkola MS, Jaakkola JJK. Cold weather increases respiratory symptoms and functional disability especially among patients with asthma and allergic rhinitis. Sci Rep [Internet]. 2018 Jul 4 [cited 2020 Apr 5];8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031646/</ref> Epidemics like influenza have known to show a marked wintertime seasonality with over 2-3-month period within the months of November and March thus underlining the presence of cold air in atmosphere.<ref name="ref48">Lowen AC, Steel J. Roles of Humidity and Temperature in Shaping Influenza Seasonality. J Virol. 2014 Jul;88(14):7692–5.</ref> Atiabhishyandi or excessively humid air can intensify the heat and perspiration and trigger the respiratory conditions like asthma and COPD.<ref name="ref49">Choi SH, Lee SW, Hong YS, Kim SJ, Kim NH. Effects of atmospheric temperature and humidity on outbreak of diseases. Emerg Med Australas. 2007 Dec;19(6):501–8.</ref> Ati-ushna vayu indicates the excessive rise in temperature which can cause heat stress related conditions like heat exhaustion and can also be a resultant of climate change and heat waves. It can also result in excessive dehydration.<ref name="ref50">Kovats RS, Hajat S. Heat stress and public health: a critical review. Annu Rev Public Health. 2008;29:41–55.</ref> Asatmya gandha indicates theodour pollution which is not only a determinant of environmental pollution but can also affect the physical health of community. It can result in occurrence of symptoms like wheezing, asthma, cough, headache, nausea and even mental stress related outcomes like mood changes.<ref name="ref51">Tjalvin G, Magerøy N, Bråtveit M, Lygre Shl, Hollund Be, Moen Be. Odour as a determinant of persistent symptoms after a chemical explosion, a longitudinal study. Ind Health. 2017 Mar;55(2):127–37.</ref> The particulate matter or presence of pollutants in air is pressing problem due to advent of globalization and industrialization can also be correlated with asatmya gandha. Exposure to particulate matter can lead to reduced lung function, development of lung diseases like COPD, occupational lung diseases and even death.<ref name="ref52">Kelly FJ, Fussell JC. Air pollution and public health: emerging hazards and improved understanding of risk. Environ Geochem Health. 2015;37(4):631–49.</ref> Dushita Jala (impure water) also acts a carrier or cause of many epidemiological and endemic disorders. Most intestinal or enteric diseases are water borne infections. These are transmitted through faecal waste when the water is polluted by faecal matter.<ref name="ref53">Health impacts of water pollution [Internet]. [cited 2020 Apr 5]. Available from: http://edugreen.teri.res.in/explore/water/health.html</ref> Minamata Bay disease is excellent example of possible outbreak of severe disease through water pollution.<ref name="ref54">Harada M. Minamata disease: methylmercury poisoning in Japan caused by environmental pollution. Crit Rev Toxicol. 1995;25(1):1–24.</ref> Many water borne bacterial infections can result in occurrence of disease like Typhoid(caused by Salmonella typhi), bacillary dysentery (caused by Shigella), viral infections like infectious hepatitis(Hepatitis A), Cholera(caused by Vibrio) and protozoal infections like amoebiasis, giardiasis etc. Upakranta and upaksheena Jalashaya indicate occurrence of famines and droughts. Droughts have far fetching consequences on the quality of public health resulting in the rise in infectious and nutrition related diseases. It results in shortage of drinking water and poor waterquality and lack of hygiene.<ref name="ref55">Health Implications of Drought | CDC [Internet]. 2020 [cited 2022 Jan 19]. Available from: https://www.cdc.gov/nceh/drought/implications.html</ref> Access to safe and quality drinking water is the prime necessity for livelihood. WHO has put forth guidelines and standards to rectify the quality of drinking water to safeguard the health of population. Waterborne diseases resulting from consumption of unhealthy drinking water poses a great threat to the high risk population like children, geriatric population, pregnant women and those suffering from debilitating diseases. The water quality can be affected by microbial content, presence of impurities like heavy metals, faecal matter and other solvents making it unsafe for consumption.<ref name="ref56">World Health Organization. Guidelines for drinking-water quality: first addendum to the third edition, volume 1 : recommendations. Geneva: WHO; 2006.</ref> Desha dushti the third factor leading to causation of janapadodhvansa can be understood as soil pollution that results from exposure to soil with altered quality as there can be ingestion, inhalation or dermal absorption of the pollutants present in the soil.<ref name="ref57">Landrigan PJ, Fuller R. Environmental pollution: An enormous and invisible burden on health systems in low- and middle-income counties. World Hosp Health Serv. 2014;50(4):35–40.</ref> This factor is also affected by over- crowding which leads to the lack of hygiene and sanitation increasing the risk of spread of infectious disorders. It can result in overburdening of healthcare facilities and lack of sustainable development, further intensifying the environmental pollution. Ecosystems have direct or indirect impact on health as they are major source of food, water, supplies and even livelihood for the population.<ref name="ref58">Corvalán C, Hales S, McMichael AJ, Millennium Ecosystem Assessment (Program), World Health Organization, editors. Ecosystems and human well-being: health synthesis. Geneva, Switzerland: World Health Organization; 2005. 53 p. (Millennium ecosystem assessment)</ref> Disturbed ecosystems lead to the outbreak of various Zoonotic diseases. For instance, the overabundance of vectors like makshika (flies), mashaka (mosquitos) can relate to the spread of vector borne diseases like dengue and chikungunya. The natural disasters like ulka patina (meteors) and bhoomikapana (earthquakes) indicate the emphasis of Acharya on the physical, mental, social, economic burden caused by such mishaps on the millions of people increasing the incidence of morbidity and mortality due communicable diseases as well. <br/>Kala factor is the most important amongst the aforesaid factors as it directly indicates the climate changes which is beyond intervention by human efforts. As mentioned earlier the spread and cause of infectious diseases follows a cyclic or calendar pattern and seasonal changes can lead to sudden rise of epidemic outbreaks.<ref name="ref59">Martinez ME. The calendar of epidemics: Seasonal cycles of infectious diseases. PLOS Pathogens. 2018 Nov 8;14(11):e1007327.</ref>

<li style="font-weight:bold">Epidemiological triad: <span style="font-weight:normal">Causative factors of janapadodhvansa can be compared to epidemiological triad which involves the external agent, susceptible host and environment. Interaction of these three components always leads to disease causation in large population and can be applied to both communicable and non-communicable diseases.<ref name="ref40">Principles of Epidemiology | Lesson 1 - Section 8 [Internet]. 2019 [cited 2020 Apr 9]. Available from: https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section8.html</ref> The concept of janapadodhvansa is similar to that of epidemic or pandemic, where epidemic is a condition affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time.<ref name="ref41">Definition of EPIDEMIC [Internet]. [cited 2020 Apr 4]. Available from: https://www.merriam-webster.com/dictionary/epidemic</ref> Pandemic is the condition occurring over a wide geographic area and affecting an exceptionally high proportion of the population.<ref name="ref42">Definition of PANDEMIC [Internet]. [cited 2020 Apr 4]. Available from: https://www.merriam-webster.com/dictionary/pandemic</ref> According to epidemiology, the causative factors affecting the contraction of disease  in population are similar to those mentioned in the chapter which includes geographic location (desha), climatic factors, biotic biological factors represented by plant related and zoological factors (vriksha (flora), mriga- pakshi (fauna)etc.) and abiotic or socioeconomic factors (janapada). The seasonality of diseases is important factor for the epidemicoutbursts throughout the globe.<ref name="ref43">Components of the Triad | Models and Mechanisms of Public Health [Internet]. [cited 2020 Apr 4]. Available from: https://courses.lumenlearning.com/suny-buffalo-environmentalhealth/chapter/components-of-the-triad/</ref> The kala factor does play an important role in disease manifestation. Deshaas mentioned earlier is important while considering the epidemiology, as outbreak of some diseases are region specific and their spread or progression also depends on the geographical, demographical and climatic conditions. It is helpful to understand the prevalence and incidence of diseases in the particular area. <br/>The description of vitiated air (vishama or vikrita vayu ) indicates climate change that increases the vulnerability of the populations to climate sensitive health risks like injury, mortality, temperature related illness (both hyperthermia and hypothermia), respiratory illnesses, zoonosis, vector borne diseases, malnutrition, communicable diseases, mental and psychosocial health etc.<ref name="ref44">Climate change and health [Internet]. [cited 2022 Jan 19]. Available from: https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health</ref> Both atichala and atikundalinam vayu can be understood as fast blowing winds, cyclones, hurricanes or tornados that can result in public health emergencies like storm related mortality, injury, infectious diseases, impairment of mental wellbeing due to socio-economic factors like displacement, unemployment, disruption of ecosystems etc.<ref name="ref45">James M. Shultz, Jill Russell, Zelde Espinel, Epidemiology of Tropical Cyclones: The Dynamics of Disaster, Disease, and Development, Epidemiologic Reviews, Volume 27, Issue 1, July 2005, Pages 21–35, https://doi.org/10.1093/epirev/mxi011</ref> Atiparusha vayu or overly dry air indicates lack of humidity or excessive dryness in air contributing to the physical health related symptoms like dry eyes, itching of skin, dry throat etc. The stress on the nasal mucosa to humidify the entering air is intensified leading to be a major cause of respiratory disorders.<ref name="ref46">Wolkoff P. Indoor air humidity, air quality, and health – An overview. International Journal of Hygiene and Environmental Health. 2018 Apr 1;221(3):376–90.</ref> Atisheeta vayu or excessive cold air like that in air conditioned environments also poses a threat to increase in respiratory infections.<ref name="ref47">Hyrkäs-Palmu H, Ikäheimo TM, Laatikainen T, Jousilahti P, Jaakkola MS, Jaakkola JJK. Cold weather increases respiratory symptoms and functional disability especially among patients with asthma and allergic rhinitis. Sci Rep [Internet]. 2018 Jul 4 [cited 2020 Apr 5];8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031646/</ref> Epidemics like influenza have known to show a marked wintertime seasonality with over 2-3-month period within the months of November and March thus underlining the presence of cold air in atmosphere.<ref name="ref48">Lowen AC, Steel J. Roles of Humidity and Temperature in Shaping Influenza Seasonality. J Virol. 2014 Jul;88(14):7692–5.</ref> Atiabhishyandi or excessively humid air can intensify the heat and perspiration and trigger the respiratory conditions like asthma and COPD.<ref name="ref49">Choi SH, Lee SW, Hong YS, Kim SJ, Kim NH. Effects of atmospheric temperature and humidity on outbreak of diseases. Emerg Med Australas. 2007 Dec;19(6):501–8.</ref> Ati-ushna vayu indicates the excessive rise in temperature which can cause heat stress related conditions like heat exhaustion and can also be a resultant of climate change and heat waves. It can also result in excessive dehydration.<ref name="ref50">Kovats RS, Hajat S. Heat stress and public health: a critical review. Annu Rev Public Health. 2008;29:41–55.</ref> Asatmya gandha indicates theodour pollution which is not only a determinant of environmental pollution but can also affect the physical health of community. It can result in occurrence of symptoms like wheezing, asthma, cough, headache, nausea and even mental stress related outcomes like mood changes.<ref name="ref51">Tjalvin G, Magerøy N, Bråtveit M, Lygre Shl, Hollund Be, Moen Be. Odour as a determinant of persistent symptoms after a chemical explosion, a longitudinal study. Ind Health. 2017 Mar;55(2):127–37.</ref> The particulate matter or presence of pollutants in air is pressing problem due to advent of globalization and industrialization can also be correlated with asatmya gandha. Exposure to particulate matter can lead to reduced lung function, development of lung diseases like COPD, occupational lung diseases and even death.<ref name="ref52">Kelly FJ, Fussell JC. Air pollution and public health: emerging hazards and improved understanding of risk. Environ Geochem Health. 2015;37(4):631–49.</ref> Dushita Jala (impure water) also acts a carrier or cause of many epidemiological and endemic disorders. Most intestinal or enteric diseases are water borne infections. These are transmitted through faecal waste when the water is polluted by faecal matter.<ref name="ref53">Health impacts of water pollution [Internet]. [cited 2020 Apr 5]. Available from: http://edugreen.teri.res.in/explore/water/health.html</ref> Minamata Bay disease is excellent example of possible outbreak of severe disease through water pollution.<ref name="ref54">Harada M. Minamata disease: methylmercury poisoning in Japan caused by environmental pollution. Crit Rev Toxicol. 1995;25(1):1–24.</ref> Many water borne bacterial infections can result in occurrence of disease like Typhoid(caused by Salmonella typhi), bacillary dysentery (caused by Shigella), viral infections like infectious hepatitis(Hepatitis A), Cholera(caused by Vibrio) and protozoal infections like amoebiasis, giardiasis etc. Upakranta and upaksheena Jalashaya indicate occurrence of famines and droughts. Droughts have far fetching consequences on the quality of public health resulting in the rise in infectious and nutrition related diseases. It results in shortage of drinking water and poor waterquality and lack of hygiene.<ref name="ref55">Health Implications of Drought | CDC [Internet]. 2020 [cited 2022 Jan 19]. Available from: https://www.cdc.gov/nceh/drought/implications.html</ref> Access to safe and quality drinking water is the prime necessity for livelihood. WHO has put forth guidelines and standards to rectify the quality of drinking water to safeguard the health of population. Waterborne diseases resulting from consumption of unhealthy drinking water poses a great threat to the high risk population like children, geriatric population, pregnant women and those suffering from debilitating diseases. The water quality can be affected by microbial content, presence of impurities like heavy metals, faecal matter and other solvents making it unsafe for consumption.<ref name="ref56">World Health Organization. Guidelines for drinking-water quality: first addendum to the third edition, volume 1 : recommendations. Geneva: WHO; 2006.</ref> Desha dushti the third factor leading to causation of janapadodhvansa can be understood as soil pollution that results from exposure to soil with altered quality as there can be ingestion, inhalation or dermal absorption of the pollutants present in the soil.<ref name="ref57">Landrigan PJ, Fuller R. Environmental pollution: An enormous and invisible burden on health systems in low- and middle-income counties. World Hosp Health Serv. 2014;50(4):35–40.</ref> This factor is also affected by over- crowding which leads to the lack of hygiene and sanitation increasing the risk of spread of infectious disorders. It can result in overburdening of healthcare facilities and lack of sustainable development, further intensifying the environmental pollution. Ecosystems have direct or indirect impact on health as they are major source of food, water, supplies and even livelihood for the population.<ref name="ref58">Corvalán C, Hales S, McMichael AJ, Millennium Ecosystem Assessment (Program), World Health Organization, editors. Ecosystems and human well-being: health synthesis. Geneva, Switzerland: World Health Organization; 2005. 53 p. (Millennium ecosystem assessment)</ref> Disturbed ecosystems lead to the outbreak of various Zoonotic diseases. For instance, the overabundance of vectors like makshika (flies), mashaka (mosquitos) can relate to the spread of vector borne diseases like dengue and chikungunya. The natural disasters like ulka patina (meteors) and bhoomikapana (earthquakes) indicate the emphasis of Acharya on the physical, mental, social, economic burden caused by such mishaps on the millions of people increasing the incidence of morbidity and mortality due communicable diseases as well. <br/>Kala factor is the most important amongst the aforesaid factors as it directly indicates the climate changes which is beyond intervention by human efforts. As mentioned earlier the spread and cause of infectious diseases follows a cyclic or calendar pattern and seasonal changes can lead to sudden rise of epidemic outbreaks.<ref name="ref59">Martinez ME. The calendar of epidemics: Seasonal cycles of infectious diseases. PLOS Pathogens. 2018 Nov 8;14(11):e1007327.</ref>

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