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Janapadodhvansa (also spelled as janapadodhvamsa) means destruction of communities due to a common cause. The affliction of [[Vyadhi|diseases]] in society disrupting the physical, psychological, social [[Health|health]] of community is phenomenon observed since inception of [[Ayu|life]] on the earth. The pandemic and epidemic situations are considered to be as old as human evolution. [[Ayurveda|Ayurveda]] texts have thus also extensively mentioned the pandemic conditions at various places commonly referred to as janapadodhvansa, maraka or janamara. Acharya Charak has explained the concept of ~~janapadodhvansain~~ vimana sthana of the treatise Charak samhita. The concept of janapadodhvansais thus reference point for the description of disease origin and spread in the population highlighting the principles of epidemiology in [[Ayurveda|ayurveda]].

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Janapadodhvansa (also spelled as janapadodhvamsa) means destruction of communities due to a common cause. The affliction of [[Vyadhi|diseases]] in society disrupting the physical, psychological, social [[Health|health]] of community is phenomenon observed since inception of [[Ayu|life]] on the earth. The pandemic and epidemic situations are considered to be as old as human evolution. [[Ayurveda|Ayurveda]] texts have thus also extensively mentioned the pandemic conditions at various places commonly referred to as janapadodhvansa, maraka or janamara. Acharya Charak has explained the concept of janapadodhvansa in [[Vimana Sthana|vimana sthana]] of the treatise [[Charak Samhita New Edition|Charak samhita]]. The concept of janapadodhvansais thus reference point for the description of [[Vyadhi|disease]] origin and spread in the population highlighting the principles of epidemiology in [[Ayurveda|ayurveda]].

{{Infobox

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== What is janapadodhvansa? ==

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Janapadodhvansa is defined as a phenomenon in which a large population is inflicted with one particular [[Vyadhi|disease]] irrespective of their prakriti (phenotype), ahara (dietary habits), dehabala (innate immunity and strength), satmya (behavioural habits and lifestyle) and sattva (mental conditions), vayasa (age group) (Cha.Sa. Vimana Sthana 3/6)

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Janapadodhvansa is defined as a phenomenon in which a large population is inflicted with one particular [[Vyadhi|disease]] irrespective of their [[Prakriti|prakriti]] (phenotype), [[Ahara|ahara]] (dietary habits), dehabala (innate immunity and strength), [[Satmya|satmya]] (behavioural habits and lifestyle) and [[Sattva|sattva]] (mental conditions), vayasa (age group) (Cha.Sa. [[Vimana Sthana|Vimana Sthana]] 3/6)

== Etymology ==

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== Synonyms of janapadodhvansa ==

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Janapadodhvansa is quoted as janamara by Acharya Bhela and Maraka by Acharya Sushrut (Su. Sa. Sutra Sthana 6/19) indicating the prevalence of epidemics in those times as well.

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Janapadodhvansa is quoted as janamara by Acharya Bhela and Maraka by Acharya Sushrut (Su. Sa. [[Sutra Sthana|Sutra Sthana]] 6/19) indicating the prevalence of epidemics in those times as well.

== Causes of janapadodhvansa ==

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Two types of causes of origin of [[Vyadhi|diseases]] ([[Vyadhi|vyadhi]]-utpatti hetu) are described. Common aetiological factors (sadharana hetu) can produce [[Vyadhi|diseases]] in almost all the beings (bahujana sadharana).Specific etiological factors (asadharana hetu) are personalized and differ from individual to individual. (Chakrapani on Cha. Sa. Vimana Sthana 3/3)Janapadodhvansa chapter deals with the common causes of [[Vyadhi|disease]] occurrence in large community. The four main environmental factors like vata (vitiated air or atmospheric factors), jala (vitiated water), desha (geographical factors or those related to vitiated land and soil resources), kaala (seasonal and climatic conditions)are focused to cause epidemic situations. (Cha. Sa Vimana Sthana 3/6). These can be summarized as given in the table below: (Table No. 1 – Entity causative of janapadodhvansa and its interpretation in present context)

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Two types of causes of origin of [[Vyadhi|diseases]] ([[Vyadhi|vyadhi]]-utpatti hetu) are described. Common aetiological factors (sadharana hetu) can produce [[Vyadhi|diseases]] in almost all the beings (bahujana sadharana).Specific etiological factors (asadharana hetu) are personalized and differ from individual to individual. (Chakrapani on Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 3/3)Janapadodhvansa chapter deals with the common causes of [[Vyadhi|disease]] occurrence in large community. The four main environmental factors like [[Vata dosha|vata]] (vitiated air or atmospheric factors), [[Jala mahabhuta|jala]] (vitiated water), [[Desha|desha]] (geographical factors or those related to vitiated land and soil resources), kaala (seasonal and climatic conditions) are focused to cause epidemic situations. (Cha. Sa [[Vimana Sthana|Vimana Sthana]] 3/6). These can be summarized as given in the table below: (Table No. 1 – Entity causative of janapadodhvansa and its interpretation in present context)

{| class="wikitable" style="text-align:justify; text-align:left;"

! Entity

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|- style="vertical-align:top;"

|rowspan="10"| Vayu

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| Vishama vayu - showing characteristics contradictory to ~~normalair~~ conditions

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| Vishama vayu - showing characteristics contradictory to normal air conditions

| This represents the climate change that causes impact on the social and environmental determinants of [[Health|health]].<ref name="ref1">Climate change [Internet]. [cited 2022 Jan 23]. Available from: https://www.who.int/westernpacific/health-topics/climate-change</ref>

|-

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| This can be correlated with low air humidity resulting in excessive dryness in air especially indoor air.<ref name="ref4">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>

|-

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| Ati sheeta- excessive cold air

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| Ati [[Sheeta|sheeta]]- excessive cold air

| Exposure to cold weather which can occur in the high altitude regions and extremes of climate especially during winter season.<ref name="ref5">Cold Related Illnesses | NIOSH |CDC [Internet]. 2020 [cited 2022 Jan 23]. Available from: https://www.cdc.gov/niosh/topics/coldstress/coldrelatedillnesses.html</ref>

|-

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| Cycloneis a system of storms or winds that rotate at centre of atmosphere with at a very high speed usually associated with heavy rains.<ref name="ref8">Definition of CYCLONE [Internet]. [cited 2022 Jan 21]. Available from: https://www.merriam-webster.com/dictionary/cyclone</ref> It possesses potential to destruct habitations over a large area.

|-

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| Asatmya gandha – foul smelling

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| Asatmya [[Gandha|gandha]] – foul smelling

| Odor pollution is emerging risk factor for the populations exposed to industrial pollution, generalized climate change and environmental pollution.<ref name="ref9">Ranveer A, Pawar P, Latake P. Odour Pollution and Its Measurement. International Journal for Research in Applied Science & Engineering Technology (IJRASET). 2015 Dec 1;3:221–9.</ref>

|-

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|- style="vertical-align:top;"

|rowspan="4"| Udaka (water)

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| Vikruta gandha- altered odour Vikruta varna- altered colour Vikruta rasa- altered taste Vikruta sparsha, kleda bahula – altered consistency.

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| Vikruta [[Gandha|gandha]] - altered odour Vikruta [[Varna|varna]] - altered colour Vikruta [[Rasa|rasa]] - altered taste Vikruta sparsha, kleda bahula – altered consistency.

| These are the indicators of water pollution. All these conditions depict lack of acceptability of drinking water due to the presence of taste and odour which is otherwise absent in water suitable for consumption.<ref name="ref11">Water Quality Monitoring - A Practical Guide to the Design and Implementation of Freshwater Quality Studies and Monitoring Programmes, Edited by Jamie Bartram and Richard Balance, Published on behalf of United Nations Environment Programme and the World Health Organization, 1996, Page No.-1,2</ref>

|-

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| The water quality is affected by pollutants and particulate matter rendering it undesirable taste, odour, colour and consistency. If the drinking water is not of optimum quality, it threatens the overall [[Health|health]] of community.<ref name="ref14">Common Perceptible Water Quality Issues [Internet]. [cited 2020 Apr 5]. Available from: https://www.wqa.org/learn-about-water/perceptible-issues</ref>

|- style="vertical-align:top;"

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|rowspan="5"| Desha (Soil or region)

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|rowspan="5"| [[Desha|Desha]] (Soil or region)

| Dhoomrapavana – region having polluted atmosphere. Kshubhita salilashaya – pollution of available water resources.

| This can be compared with environmental pollution, overcrowding, altered quality of soil and water, lack of sanitation and resources.<ref name="ref15">Briggs D. Environmental pollution and the global burden of [[Vyadhi|disease]]. Br Med Bull. 2003 Dec 1;68(1):1–24.</ref>

|-

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| Vikruta varna – alteration in normal colour Vikruta gandha – altered smell, presence of odour otherwise absent in the drinking water vikruta sparsha – altered texture or consistency of water Kledabahula – excessive water content in the atmosphere or presence of stickiness

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| Vikruta [[Varna|varna]] – alteration in normal colour Vikruta [[Gandha|gandha]] – altered smell, presence of odour otherwise absent in the drinking water vikruta sparsha – altered texture or consistency of water Kledabahula – excessive water content in the atmosphere or presence of stickiness

| This indicates the soil pollution. It is defined as the presence of toxic chemicals in the form of pollutants or contaminants in soil, in concentrations high enough to cause a risk to human [[Health|health]] and/or the ecosystem.<ref name="ref16">What Is Soil Pollution | Environmental Pollution Centers [Internet]. [cited 2022 Jan 23]. Available from: https://www.environmentalpollutioncenters.org/soil/</ref>

|-

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|-

|}

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Acharya Sushruta states vyapanna ritu (unfavourable seasons) as the primary cause of janapadodhvansa or maraca. Seasonal variations whether gradual or transient lead to disturbance in equilibrium of doshas, thus affecting the [[Health|health]] of population. (Su. Sa. Sutra Sthana 6/21)

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Acharya Sushruta states vyapanna ritu (unfavourable seasons) as the primary cause of janapadodhvansa or maraca. Seasonal variations whether gradual or transient lead to disturbance in equilibrium of doshas, thus affecting the [[Health|health]] of population. (Su. Sa. [[Sutra Sthana|Sutra Sthana]] 6/21)

== Adharma (inappropriate bahaviour) as a cause ==

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Adharma (inappropriate behaviour) is another cause of janapadodhvansa can be described as not abiding to one’s prescribed duties and responsibilities. (Cha. Sa. Vimana Sthana 3/24) This can be associated with the human conduct and behaviour responsible for the occurrence of [[Vyadhi|diseases]]. This reflects on the social determinants of [[Health|health]]. The researches have proved that human behaviour is equally responsible in occurrence of epidemics as it results in excessive exploitation of natural resources, increase in pollution, increase in incidence of warfare, decreased social harmony, disturbance of ecosystems and deterioration of universal [[Health|health]].<ref name="ref21">Funk S, Salathé M, Jansen VAA. Modelling the influence of human behaviour on the spread of infectious diseases: a review. J R Soc Interface. 2010 Sep 6;7(50):1247–56.</ref> Pragyaparadha (intellectual errors), shashtraprabhava (warfare), rakshogana (infectious conditions) and abhishapa (inappropriate social behaviour) are social, behavioral determinants of [[Health|health]]. These can be termed as host specific factors for [[Vyadhi|disease]] occurrence. Adharma as a hetu of janapadodhvansa can be illustrated in the table as given below (Table No. 2-Hetu of janapadodhvansa in purview of adharma)

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Adharma (inappropriate behaviour) is another cause of janapadodhvansa can be described as not abiding to one’s prescribed duties and responsibilities. (Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 3/24) This can be associated with the human conduct and behaviour responsible for the occurrence of [[Vyadhi|diseases]]. This reflects on the social determinants of [[Health|health]]. The researches have proved that human behaviour is equally responsible in occurrence of epidemics as it results in excessive exploitation of natural resources, increase in pollution, increase in incidence of warfare, decreased social harmony, disturbance of ecosystems and deterioration of universal [[Health|health]].<ref name="ref21">Funk S, Salathé M, Jansen VAA. Modelling the influence of human behaviour on the spread of infectious diseases: a review. J R Soc Interface. 2010 Sep 6;7(50):1247–56.</ref> Pragyaparadha (intellectual errors), shashtraprabhava (warfare), rakshogana (infectious conditions) and abhishapa (inappropriate social behaviour) are social, behavioral determinants of [[Health|health]]. These can be termed as host specific factors for [[Vyadhi|disease]] occurrence. Adharma as a hetu of janapadodhvansa can be illustrated in the table as given below (Table No. 2-Hetu of janapadodhvansa in purview of adharma)

{| class="wikitable" style="text-align:justify; text-align:left;"

!colspan="2"| Hetu of janapadodhvansa in purview of adharma

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== Jwara (fever) as a prime linga (~representative symptom) of janapadodhvansajanya [[Vyadhi|vyadhi]] ==

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Jwara is characterized as a condition affecting both physical and mental wellbeing. It is the chief disorder amongst all other [[Vyadhi|diseases]] affecting every living being at the time of birth and death. (Cha. Sa. Nidana Sthana 1/35) Most of the epidemics related to infectious [[Vyadhi|diseases]] are types of influenza or are almost always associated with fever.<ref name="ref26">Microbial Threats I of M (US) F on. Infectious Disease Emergence: Past, Present, and Future [Internet]. Microbial Evolution and Co-Adaptation: A Tribute to the Life and Scientific Legacies of Joshua Lederberg: Workshop Summary. National Academies Press (US); 2009 [cited 2020 Apr 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45714/</ref> Outbreak of Spanish Flu, dengue fever, swine flu, bird flu, typhoid, cholera, and even the present day COVID-19 are examples of jwara that resulted in some or the other form of janapadodhvansa.<ref name="ref27">Baker RE, Mahmud AS, Miller IF, et al. Infectious disease in an era of global change. Nat Rev Microbiol. 2022;20(4):193-205. doi:10.1038/s41579-021-00639-z</ref> Sushruta (Su. Sa. Sutra Sthana 6/21) on the other hand has also explained few other manifestations of maraka like kasa (cough, bronchitis, lower respiratory tract infections), shwasa (respiratory infections, pneumonia), vamathu (gastric disturbance, nausea), pratishyaya (rhinitis, coryza or upper respiratory tract infections), shiroruja (headache)besides jwara. These are also commonly observed infectious [[Vyadhi|diseases]] posing havoc in the community. Similarly, Sushruta mentions that the infection can also spread through surface contact with things like beddings, blankets, seating arrangement, vehicles, jewellery and accessories. (Su. Sa. Sutra Sthana 6/21)

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Jwara is characterized as a condition affecting both physical and mental wellbeing. It is the chief disorder amongst all other [[Vyadhi|diseases]] affecting every living being at the time of birth and death. (Cha. Sa. Nidana Sthana 1/35) Most of the epidemics related to infectious [[Vyadhi|diseases]] are types of influenza or are almost always associated with fever.<ref name="ref26">Microbial Threats I of M (US) F on. Infectious Disease Emergence: Past, Present, and Future [Internet]. Microbial Evolution and Co-Adaptation: A Tribute to the Life and Scientific Legacies of Joshua Lederberg: Workshop Summary. National Academies Press (US); 2009 [cited 2020 Apr 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45714/</ref> Outbreak of Spanish Flu, dengue fever, swine flu, bird flu, typhoid, cholera, and even the present day COVID-19 are examples of jwara that resulted in some or the other form of janapadodhvansa.<ref name="ref27">Baker RE, Mahmud AS, Miller IF, et al. Infectious disease in an era of global change. Nat Rev Microbiol. 2022;20(4):193-205. doi:10.1038/s41579-021-00639-z</ref> Sushruta (Su. Sa. [[Sutra Sthana|Sutra Sthana]] 6/21) on the other hand has also explained few other manifestations of maraka like kasa (cough, bronchitis, lower respiratory tract infections), shwasa (respiratory infections, pneumonia), vamathu (gastric disturbance, nausea), pratishyaya (rhinitis, coryza or upper respiratory tract infections), shiroruja (headache)besides jwara. These are also commonly observed infectious [[Vyadhi|diseases]] posing havoc in the community. Similarly, Sushruta mentions that the infection can also spread through surface contact with things like beddings, blankets, seating arrangement, vehicles, jewellery and accessories. (Su. Sa. [[Sutra Sthana|Sutra Sthana]] 6/21)

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== Management of janapadodhvansa (Cha. Sa. Vimana Sthana 3/13-18) ==

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== Management of janapadodhvansa (Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 3/13-18) ==

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Acharya Charaka mentions the need of collection of medicinal herbs and commodities which are important for supporting the [[Ayu|life]] in emergencies or epidemics beforehand, as there can be scarcity of the even most basic [[Ayu|life]] needs during such period. (Cha. Sa. Vimana Sthana 3/4)This denotes the basis of disaster management and organisation of healthcare facilities during epidemics. The hospitals should be well prepared with all the emergency and required facilities to combat the [[Health|health]] consequences of disasters.<ref name="ref28">Hospital Preparedness for Epidemics [Internet]. [cited 2020 Apr 9]. Available from: https://www.who.int/publications-detail/hospital-preparedness-for-epidemics</ref> The principal line of treatment in the management of [[Vyadhi|diseases]] like jwara is pachana (medications enhancing digestion), vamana (therapeutic emesis) and apatarpana (depleting procedures). (Cha. Sa. Vimana Sthana 3/40) Ushnodaka (warm water) helps in achieving all the above criteria. It is also indicated for the treatment of jwara as it pacifies vata and kapha dosha. (Cha. Sa. Vimana Sthana 3/40) It facilitates digestion and relieves anorexia due to its deepana (appetizing), pachana (digestion) properties. It satiatestrishna (thirst), when consumed even in small quantities. Its consumption is especially indicated in management of conditions like kasa (cough), peenasa (sinusitis), nava jwara (pyrexia), shwasa (breathing abnormality), etc. which represent majority of infectious [[Vyadhi|diseases]].(Cha. Sa. Chikitsa Sthana 22/58) The generalized principles for management of janapadodhvansa include the measures for the promotion, preservation and correction of both physical and mental [[Health|health]]. The panchakarma is the main line of treatment in these conditions. (Cha. Sa. Vimana Sthana 3/13) Vamana is important for the radical removal of vitiated dosha especially the kapha dosha and helps in pacifying the jwara and nausea (hrillasa) related conditions associated with the infection. (Cha. Sa. Chikitsa Sthana 3/146) Virechana also helps to evacuate the vitiated dosha through the faeces and corrects the agni vitiation. (Cha. Sa. Chikitsa Sthana 3/169) Basti controls the vitiated vata and helps in excretion of the toxins and faecal matter from the bowel region. (Cha. Sa. Siddhi Sthana 1/40) Due to nasya or nasal instillation invading pathogens get adsorbed on the surface restricting their growth and further progressiom. Nasya is thus particularly useful in the treatment and prevention of respiratory tract infections. Snehana (internal administration of ghee or oil) in form of go-ghrita ( ghee). Jwara involves the obstruction of swedavaha strotas ( body channels carrying sweat) hence it will help to expel the toxins by inducing the process of swedana. (Cha. Sa. Chikitsa Sthana 3/130) Deepana pachana treatments play an important role at every step in management as maintenance of agni function is of prime importance in prevention of any [[Vyadhi|disease]]. Dhoomapana is a treatment where the particulate matter in dhooma (medicated smoke) has anti-microbial activity and maintains integrity of respiratory tract. It is thus indicated in many respiratory conditions (Cha. Sa. Sutra Sthana 5/27-32).Gandusha (Oil pulling),kavala (gargling), dantapavana (brushing or cleaning of teeth) act as mechanical barriers by avoiding the entry of pathogens through the buccal cavity.Sharira parimarjana (cleaning of body surface) and snana (bathing) measures contribute to cleansing of the body surfaces and also includes hasta,pada and mukha prakshalana i.e. hand and feet sanitization to prevent the spread of [[Vyadhi|disease]]. (Cha. Sa. Sutra Sthana 5/93-94)

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Acharya Charaka mentions the need of collection of medicinal herbs and commodities which are important for supporting the [[Ayu|life]] in emergencies or epidemics beforehand, as there can be scarcity of the even most basic [[Ayu|life]] needs during such period. (Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 3/4)This denotes the basis of disaster management and organisation of healthcare facilities during epidemics. The hospitals should be well prepared with all the emergency and required facilities to combat the [[Health|health]] consequences of disasters.<ref name="ref28">Hospital Preparedness for Epidemics [Internet]. [cited 2020 Apr 9]. Available from: https://www.who.int/publications-detail/hospital-preparedness-for-epidemics</ref> The principal line of treatment in the management of [[Vyadhi|diseases]] like jwara is pachana (medications enhancing digestion), vamana (therapeutic emesis) and apatarpana (depleting procedures). (Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 3/40) Ushnodaka (warm water) helps in achieving all the above criteria. It is also indicated for the treatment of jwara as it pacifies [[Vata dosha|vata]] and kapha dosha. (Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 3/40) It facilitates digestion and relieves anorexia due to its deepana (appetizing), pachana (digestion) properties. It satiatestrishna (thirst), when consumed even in small quantities. Its consumption is especially indicated in management of conditions like kasa (cough), peenasa (sinusitis), nava jwara (pyrexia), shwasa (breathing abnormality), etc. which represent majority of infectious [[Vyadhi|diseases]].(Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 22/58) The generalized principles for management of janapadodhvansa include the measures for the promotion, preservation and correction of both physical and mental [[Health|health]]. The panchakarma is the main line of treatment in these conditions. (Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 3/13) Vamana is important for the radical removal of vitiated dosha especially the kapha dosha and helps in pacifying the jwara and nausea (hrillasa) related conditions associated with the infection. (Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 3/146) Virechana also helps to evacuate the vitiated dosha through the faeces and corrects the agni vitiation. (Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 3/169) Basti controls the vitiated [[Vata dosha|vata]] and helps in excretion of the toxins and faecal matter from the bowel region. (Cha. Sa. Siddhi Sthana 1/40) Due to nasya or nasal instillation invading pathogens get adsorbed on the surface restricting their growth and further progressiom. Nasya is thus particularly useful in the treatment and prevention of respiratory tract infections. Snehana (internal administration of ghee or oil) in form of go-ghrita ( ghee). Jwara involves the obstruction of swedavaha strotas ( body channels carrying sweat) hence it will help to expel the toxins by inducing the process of swedana. (Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 3/130) Deepana pachana treatments play an important role at every step in management as maintenance of agni function is of prime importance in prevention of any [[Vyadhi|disease]]. Dhoomapana is a treatment where the particulate matter in dhooma (medicated smoke) has anti-microbial activity and maintains integrity of respiratory tract. It is thus indicated in many respiratory conditions (Cha. Sa. [[Sutra Sthana|Sutra Sthana]] 5/27-32).Gandusha (Oil pulling),kavala (gargling), dantapavana (brushing or cleaning of teeth) act as mechanical barriers by avoiding the entry of pathogens through the buccal cavity.Sharira parimarjana (cleaning of body surface) and snana (bathing) measures contribute to cleansing of the body surfaces and also includes hasta,pada and mukha prakshalana i.e. hand and feet sanitization to prevent the spread of [[Vyadhi|disease]]. (Cha. Sa. [[Sutra Sthana|Sutra Sthana]] 5/93-94)

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The rasayana chikitsa forms the backbone of treatment of janapadodhvansa as it is pivotal in enhancing the immune response to pathogenic external and internal invasion and stress. (Cha. Sa. Vimana Sthana 3/13)Different rasayana acting on pranavaha, rasavaha strotas, annavaha strotas depending on the dosha and site involvement can thus be implemented for management of janapadodhvansa [[Vyadhi|vyadhi]]. Use of various rasayana like Chyavanaprasha rasayana (Cha. Sa. Chikitsa Sthana 1/1/62-74), Bramha rasayana (Cha. Sa. Chikitsa Sthana 1/1/41-57), Amalaki rasayana (Cha. Sa. Chikitsa Sthana 1/2/9-14) etc. are popular in clinical scenario for of maintenance of [[Health|health]] during pandemic conditions. Other non-pharmacological and psychotherapy based approaches like sadvritta palana (following proper code of conduct) and behavioural attributes like satyabhashana (honesty), bhootadaya (compassion), bali (sacrifice), devata archana (devotion), daana (charity), vriddhopaseva (showing care and empathy towards the elderly) are mentioned to facilitate the social and mental [[Health|health]]. Providing support and care to people and families affected with pandemics is of vital importance to balance the psychological components of [[Health|health]] especially during the pandemic like conditions. (Cha. Sa. Vimana Sthana 3/15-16) Sadvritta emphasizes on the spread and containment of the sansargajanya vyadhi (infectious [[Vyadhi|diseases]]) and their mode of transmission. (Cha. Sa. Sutra Sthana 8/18) The sadvritta focuses on various domains like physical [[Health|health]], social behaviour, psychological state, hygiene, food etiquettes thus providing holistic care. The treatment and preventive aspects of epidemics in purview of ayurveda can be summarized in the following table-

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The [[Rasayana Adhyaya|rasayana chikitsa]] forms the backbone of treatment of janapadodhvansa as it is pivotal in enhancing the immune response to pathogenic external and internal invasion and stress. (Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 3/13)Different [[Rasayana|rasayana]] acting on pranavaha, rasavaha strotas, annavaha strotas depending on the dosha and site involvement can thus be implemented for management of janapadodhvansa [[Vyadhi|vyadhi]]. Use of various [[Rasayana|rasayana]] like Chyavanaprasha [[Rasayana|rasayana]] (Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 1/1/62-74), Bramha [[Rasayana|rasayana]] (Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 1/1/41-57), Amalaki [[Rasayana|rasayana]] (Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 1/2/9-14) etc. are popular in clinical scenario for of maintenance of [[Health|health]] during pandemic conditions. Other non-pharmacological and psychotherapy based approaches like sadvritta palana (following proper code of conduct) and behavioural attributes like satyabhashana (honesty), bhootadaya (compassion), bali (sacrifice), devata archana (devotion), daana (charity), vriddhopaseva (showing care and empathy towards the elderly) are mentioned to facilitate the social and mental [[Health|health]]. Providing support and care to people and families affected with pandemics is of vital importance to balance the psychological components of [[Health|health]] especially during the pandemic like conditions. (Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 3/15-16) Sadvritta emphasizes on the spread and containment of the sansargajanya vyadhi (infectious [[Vyadhi|diseases]]) and their mode of transmission. (Cha. Sa. [[Sutra Sthana|Sutra Sthana]] 8/18) The sadvritta focuses on various domains like physical [[Health|health]], social behaviour, psychological state, hygiene, food etiquettes thus providing holistic care. The treatment and preventive aspects of epidemics in purview of ayurveda can be summarized in the following table-

{| class="wikitable" style="text-align:justify;"

! style="text-align:left;" colspan="2"| Other measures to ensure the promotion of [[Health|health]]

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|

* Sadvritta is the righteous code of conduct representing different aspects of hygiene, social conduct, morals and behaviour.

−

* These measures include regular cleansing and trimming of nails (nakhakartana), hygiene and regular cleansing of external orifices (malayana shodhana), daily bath (snana), use of fragrances (gandhopasevana) in order to arrest the foul odour, to cover ones face while experiencing sneeze, laughter or yawn and avoiding touching of face and nasal area.(Cha. Sa. Sutra Sthana 8/18-19)

+

* These measures include regular cleansing and trimming of nails (nakhakartana), hygiene and regular cleansing of external orifices (malayana shodhana), daily bath (snana), use of fragrances (gandhopasevana) in order to arrest the foul odour, to cover ones face while experiencing sneeze, laughter or yawn and avoiding touching of face and nasal area.(Cha. Sa. [[Sutra Sthana|Sutra Sthana]] 8/18-19)

|-

| Shivanam upasevanaam (using means of protection)

Line 211: Line 211:

The concept of janapadodhvansa incorporates various aspects leading to causation of large number of [[Vyadhi|diseases]] in large population or community. This further applies to the basics of public [[Health|health]] or community [[Health|health]] as mentioned in the [[Ayurveda|Ayurveda]] texts. Thus striking similarities can be found in principles of epidemiology and concept of janapadodhvansa or maraka according to [[Ayurveda|ayurveda]]. Some of these features are as mentioned below:

−

<li style="font-weight:bold">Endemic nature of [[Vyadhi|diseases]]: In janapadodhvansa chapter it is mentioned that Punarvasu Atreya assembled with his disciples including Agnivesha at banks of the river Ganga in Panchal Pradesh (present Northern India including regions of Uttar Pradesh). This is important to understand the region specificity or occurrence of the endemic [[Vyadhi|diseases]] in the area. Endemic [[Vyadhi|disease]] is the one which is predominantly present in the population in the given area e.g. chickenpox, malaria.<ref name="ref36">Endemic Diseases-Types and Examples of Endemic Diseases [Internet]. BYJUS. [cited 2020 Apr 4]. Available from: https://byjus.com/biology/endemic-diseases/</ref> This concept can thus be correlated with medical topography which is the systematic surveying, mapping, charting, and description of specific geographical sites, with reference to the physical features that were presumed to influence [[Health|health]] and [[Vyadhi|disease]].<ref name="ref37">4 questions with answers in MEDICAL TOPOGRAPHY | Science topic [Internet]. [cited 2020 Apr 4]. Available from: https://www.researchgate.net/topic/Medical-Topography</ref> Some [[Vyadhi|diseases]] are more prevalent in northern hemisphere,, some in southern, some occur more commonly in tropical region. For instance, Plasmodium falciparum is the type of vector of malaria that is geographically located in the tropical and subtropical areas and is the most common cause of [[Vyadhi|disease]].<ref name="ref38">Darshan Babu, Pampanna Gouda UTILITY OF THE KNOWLEDGE OF DESHA – A CLINICAL PERSPECTIVE; International Ayurvedic Medical Journal; Volume 3; Issue 3; March- 2015; ISSN:2320 5091</ref> Charaka Samhita also describes three types of topographical conditions by dividing the desha into jangala, anupa and sadharana. (Cha. Sa. Vimana Sthana 3/47-48). Jangala desha (dry land) has less biota, scarce water resources, more wind and sunlight while anupa (marshy land) has abundant biota and flora, stagnant or scarce winds and lacks sunlight. Climatic conditions in jangala desha are considered optimum for [[Health|health]] and reduce the [[Vyadhi|disease]] occurrence than those in anupa desha.</li>

+

<li style="font-weight:bold">Endemic nature of [[Vyadhi|diseases]]: In janapadodhvansa chapter it is mentioned that Punarvasu Atreya assembled with his disciples including Agnivesha at banks of the river Ganga in Panchal Pradesh (present Northern India including regions of Uttar Pradesh). This is important to understand the region specificity or occurrence of the endemic [[Vyadhi|diseases]] in the area. Endemic [[Vyadhi|disease]] is the one which is predominantly present in the population in the given area e.g. chickenpox, malaria.<ref name="ref36">Endemic Diseases-Types and Examples of Endemic Diseases [Internet]. BYJUS. [cited 2020 Apr 4]. Available from: https://byjus.com/biology/endemic-diseases/</ref> This concept can thus be correlated with medical topography which is the systematic surveying, mapping, charting, and description of specific geographical sites, with reference to the physical features that were presumed to influence [[Health|health]] and [[Vyadhi|disease]].<ref name="ref37">4 questions with answers in MEDICAL TOPOGRAPHY | Science topic [Internet]. [cited 2020 Apr 4]. Available from: https://www.researchgate.net/topic/Medical-Topography</ref> Some [[Vyadhi|diseases]] are more prevalent in northern hemisphere,, some in southern, some occur more commonly in tropical region. For instance, Plasmodium falciparum is the type of vector of malaria that is geographically located in the tropical and subtropical areas and is the most common cause of [[Vyadhi|disease]].<ref name="ref38">Darshan Babu, Pampanna Gouda UTILITY OF THE KNOWLEDGE OF DESHA – A CLINICAL PERSPECTIVE; International Ayurvedic Medical Journal; Volume 3; Issue 3; March- 2015; ISSN:2320 5091</ref> Charaka Samhita also describes three types of topographical conditions by dividing the [[Desha|desha]] into jangala, anupa and sadharana. (Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 3/47-48). Jangala [[Desha|desha]] (dry land) has less biota, scarce water resources, more wind and sunlight while anupa (marshy land) has abundant biota and flora, stagnant or scarce winds and lacks sunlight. Climatic conditions in jangala [[Desha|desha]] are considered optimum for [[Health|health]] and reduce the [[Vyadhi|disease]] occurrence than those in anupa [[Desha|desha]].</li>

<li style="font-weight:bold">Seasonal [[Vyadhi|diseases]]: 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 [[Vyadhi|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></li>

−

<li style="font-weight:bold">Epidemiological triad: 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 [[Vyadhi|disease]] causation in large population and can be applied to both communicable and non-communicable [[Vyadhi|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 [[Vyadhi|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 [[Vyadhi|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 [[Vyadhi|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 [[Vyadhi|diseases]] in the particular area. The description of vitiated air (vishama or vikrita vayu ) indicates climate change that increases the vulnerability of the populations to climate sensitive [[Health|health]] risks like injury, mortality, temperature related illness (both hyperthermia and hypothermia), respiratory illnesses, zoonosis, vector borne [[Vyadhi|diseases]], malnutrition, communicable [[Vyadhi|diseases]], mental and psychosocial [[Health|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|health]] emergencies like storm related mortality, injury, infectious [[Vyadhi|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|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|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 [[Vyadhi|diseases]] like COPD, occupational lung [[Vyadhi|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 [[Vyadhi|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 [[Vyadhi|disease]] is excellent example of possible outbreak of severe [[Vyadhi|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 [[Vyadhi|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|health]] resulting in the rise in infectious and nutrition related [[Vyadhi|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|health]] of population. Waterborne [[Vyadhi|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 [[Vyadhi|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|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 [[Vyadhi|diseases]]. For instance, the overabundance of vectors like makshika (flies), mashaka (mosquitos) can relate to the spread of vector borne [[Vyadhi|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 [[Vyadhi|diseases]] as well. 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 [[Vyadhi|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: 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 [[Vyadhi|disease]] causation in large population and can be applied to both communicable and non-communicable [[Vyadhi|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 [[Vyadhi|disease]] in population are similar to those mentioned in the chapter which includes geographic location ([[Desha|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 [[Vyadhi|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 [[Vyadhi|disease]] manifestation. [[Desha|Desha]] as 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 [[Vyadhi|diseases]] in the particular area. The description of vitiated air (vishama or vikrita vayu ) indicates climate change that increases the vulnerability of the populations to climate sensitive [[Health|health]] risks like injury, mortality, temperature related illness (both hyperthermia and hypothermia), respiratory illnesses, zoonosis, vector borne [[Vyadhi|diseases]], malnutrition, communicable [[Vyadhi|diseases]], mental and psychosocial [[Health|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|health]] emergencies like storm related mortality, injury, infectious [[Vyadhi|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|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|gandha]] indicates theodour pollution which is not only a determinant of environmental pollution but can also affect the physical [[Health|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|gandha]]. Exposure to particulate matter can lead to reduced lung function, development of lung [[Vyadhi|diseases]] like COPD, occupational lung [[Vyadhi|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 [[Vyadhi|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 [[Vyadhi|disease]] is excellent example of possible outbreak of severe [[Vyadhi|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 [[Vyadhi|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|health]] resulting in the rise in infectious and nutrition related [[Vyadhi|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|health]] of population. Waterborne [[Vyadhi|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 [[Vyadhi|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|Health]] Organization. Guidelines for drinking-water quality: first addendum to the third edition, volume 1 : recommendations. Geneva: WHO; 2006.</ref> [[Desha|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 [[Vyadhi|diseases]]. For instance, the overabundance of vectors like makshika (flies), mashaka (mosquitos) can relate to the spread of vector borne [[Vyadhi|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 [[Vyadhi|diseases]] as well. 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 [[Vyadhi|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></ol>

Line 233: Line 233:

== Summary ==

−

The concept of janapadodhvansa is a testimony of the contribution of [[Ayurveda|Ayurveda]] in the field of epidemiology and public [[Health|health]]. The description of the major etiological factors like sadharana hetu (common spreading causes), adharma (not following code of conduct) and vyapanna ritu (unfavourable climatic conditions) shall be considerd while dealing with the epidemics or pandemics. Preservation of [[Health|health]] through [[Ayurveda|ayurveda]] measures like panchakarma (five purification therapies), rasayana (rejuvenation therapies), sadvritta (good code of conduct) are best measures for protection against pandemics. The treatments to promote good digestion and metabolism (deepana pachana) and [[Vyadhi|disease]] specific therapies for jwara are important in case of occurance. Hygiene of external pathways like oral hygiene, nasal mucosal protection, bath, medicated smoking are measures to prevent microbial invasion and their growh in body. Thus the treatment of janapadodhvansa is a comprehensive protocol for personal and social [[Health|health]].

+

The concept of janapadodhvansa is a testimony of the contribution of [[Ayurveda|Ayurveda]] in the field of epidemiology and public [[Health|health]]. The description of the major etiological factors like sadharana hetu (common spreading causes), adharma (not following code of conduct) and vyapanna ritu (unfavourable climatic conditions) shall be considerd while dealing with the epidemics or pandemics. Preservation of [[Health|health]] through [[Ayurveda|ayurveda]] measures like panchakarma (five purification therapies), [[Rasayana|rasayana]] (rejuvenation therapies), sadvritta (good code of conduct) are best measures for protection against pandemics. The treatments to promote good digestion and metabolism (deepana pachana) and [[Vyadhi|disease]] specific therapies for jwara are important in case of occurance. Hygiene of external pathways like oral hygiene, nasal mucosal protection, bath, medicated smoking are measures to prevent microbial invasion and their growh in body. Thus the treatment of janapadodhvansa is a comprehensive protocol for personal and social [[Health|health]].

== Related Chapters ==

−

Janapadodhvansaniya Vimana (Cha. Sa. Vimana Sthana 3), Ritucharya Adhyaya (Su. Sa. Sutrasthana 6)

+

Janapadodhvansaniya Vimana (Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 3), Ritucharya Adhyaya (Su. Sa. [[Sutra Sthana|Sutrasthana]] 6)

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