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'''Thus the three majoretiological causes of Janapadodhwans can be featured in the figure as given below- (Figure No. 1 – Major Hetu of Janapadodhvansa)'''
'''Thus the three majoretiological causes of Janapadodhwans can be featured in the figure as given below- (Figure No. 1 – Major Hetu of Janapadodhvansa)'''
[[File:Major Hetu of Janapadodhvansa.jpg|left|Figure No. 1 – Major Hetu of Janapadodhvansa]]
[[File:Major Hetu of Janapadodhvansa.jpg|left|Figure No. 1 – Major Hetu of Janapadodhvansa]]
== Jwara (fever) as a prime linga (~representative symptom) of janapadodhvansajanya vyadhi ==
<p style='text-align:justify;'>Jwara is characterized as a condition affecting both physical and mental wellbeing. It is the chief disorder amongst all other 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 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> <br/>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 diseases posing havoc in the community. <br/>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)</p>
== Management of janapadodhvansa (Cha. Sa. Vimana Sthana 3/13-18) ==
<p style='text-align:justify;'>Acharya Charaka mentions the need of collection of medicinal herbs and commodities which are important for supporting the life in emergencies or epidemics beforehand, as there can be scarcity of the even most basic 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 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> <br/>The principal line of treatment in the management of diseaseslike 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 diseases.(Cha. Sa. Chikitsa Sthana 22/58) <br/>The generalized principles for management of janapadodhvansa include the measures for the promotion, preservation and correction of both physical and mental 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 disease. <br/>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 disease. (Cha. Sa. Sutra Sthana 5/93-94)
<br/>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 janapadodhvansavyadhi. 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 during pandemic conditions. <br/>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. Providing support and care to people and families affected with pandemics is of vital importance to balance the psychological components of health especially during the pandemic like conditions. (Cha. Sa. Vimana Sthana 3/15-16) <br/>Sadvritta emphasizes on the spread and containment of the sansargajanya vyadhi (infectious diseases) and their mode of transmission. (Cha. Sa. Sutra Sthana 8/18) The sadvritta focuses on various domains like physical health, social behaviour, psychological state,hygiene, food etiquettes thus providing holistic care. <br/>The treatment and preventive aspects of epidemics in purview of ayurveda can be summarized in the following table-</p>
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