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| REVIEW ARTICLES |
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| Year : 2022 | Volume
: 10
| Issue : 3 | Page : 176-185 |
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Scientific aspects of Janapadodhwansa Vyadhi (epidemic disorders) according to Ayurveda in the context to Jwara—An epidemiological and Trisutra-based approach
Aishwarya A Joglekar1, Mahesh K Vyas1, Meera K Bhojani2
1 Department of Samhita Siddhant, All India Institute of Ayurveda, New Delhi, India
2 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India
| Date of Submission | 01-Apr-2022 |
| Date of Acceptance | 27-May-2022 |
| Date of Web Publication | 30-Sep-2022 |
Correspondence Address:
Aishwarya A Joglekar
Department of Samhita Siddhant, All India Institute of Ayurveda, Gautampuri, Sarita Vihar, New Delhi 1110076
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jism.jism_30_22
Background: Ayurveda was oriented with the management of various epidemic-like situations. Acharya Charaka has explained the concept of Janapadodhwansa (~the destruction of human community at a large scale) in Vimanasthana of the treatise Charaka Samhita. The concept of Janapadodhwansa is a mirror of the disease origin, spread, and control in the population. Aim: The aim was to critically analyze the concepts of Janapadodhwansa and epidemiology in the purview of Ayurveda and contemporary research. Materials and Methods: The concepts of epidemiology were critically analyzed in the purview of the concept of Janapadodhwansa in Ayurveda. The robust search of literature from research databases, published literature, and contemporary sciences was done to incorporate the related aspects. Observations: The major Hetu (~etiological factors) in the manifestation of Janapododhwansa can be correlated with the environmental, host, and agent components of the epidemiological triad. The four Hetu namely Vayu (~ air), Jala (~water), Desha (~environmental pollution), and Kaala (~seasonal impact) focus largely on the environment aspect of epidemiological triad, which includes host, agent, and environment, whereas the Adharma (behavioral factors) deals with the host and agent aspects. The management of epidemics explained in Ayurveda covers all the aspects of physical, mental, social, and spiritual health facilitating the promotion and preservation of health during such conditions. Jwara (~fever) is described as a condition representing the primary presentation of Janapadodhwansa, whereas other modalities such as Rasayana Sevana, Sadvritta are also rightfully discussed. Conclusions: The aspects of origin and spread of diseases like Jwara (~fever) as mentioned under the umbrella of Janapadodhwansa are similar and applicable to concepts of epidemiological triad and epidemiology in general. Keywords: Charaka Samhita, epidemiological triad, epidemiology in Ayurveda, Janapadodhwansa, Vimanasthana
How to cite this article:
Joglekar AA, Vyas MK, Bhojani MK. Scientific aspects of Janapadodhwansa Vyadhi (epidemic disorders) according to Ayurveda in the context to Jwara—An epidemiological and Trisutra-based approach. J Indian Sys Medicine 2022;10:176-85 |
How to cite this URL:
Joglekar AA, Vyas MK, Bhojani MK. Scientific aspects of Janapadodhwansa Vyadhi (epidemic disorders) according to Ayurveda in the context to Jwara—An epidemiological and Trisutra-based approach. J Indian Sys Medicine [serial online] 2022 [cited 2023 Jun 7];10:176-85. Available from: https://www.joinsysmed.com/text.asp?2022/10/3/176/357681 |
| Introduction | |  |
Ayurveda is a medical science, and the study of Roga (~diseases) causing the disruption of health is its main subject of interest. Public or community health is an issue of concern for any medical system; likewise Ayurveda was oriented with the management of various epidemics. The description of the concept of Janapadodhwansa (~the destruction of human community at a large scale) is in Vimanasthana of the treatise Charaka Samhita.[1]Vimanasthana deals with the quantification of information regarding fundamentals of Ayurveda such as Dosha (~functional factors of body) and Bheshaja (~medicine).[2] It is a proof of the presence of knowledge regarding data related to large populations in Ayurveda. The third chapter of Vimanasthana can be considered as a reference point for the origin and propagation of epidemiology in the world let alone India. According to the World Health Organisation (WHO), epidemiology is defined as the study of distribution of health-related events in the population and the application of this study to control disease and other health-related problems.[3] It is the study of diseases in human or animal population especially in terms of how, when, and where they occur.[4] The concept of Janapadodhwansa is thus the mirror of the disease origin, spread, and control in the population. The origin of Ayurveda on the earth was itself the need of an hour as mentioned at the start of treatise.[5] The world was probably in a danger of disease occurrence, and the maintenance of quality health was a prime necessity.[6] Hence, it can be derived that the concept of epidemiology is deep rooted in the basic principles of Ayurveda. The present work aims toward understanding the emergence of diseases concerning the public health in perspective of the concepts of epidemics and epidemiological triad according to Ayurveda. This is an attempt to analyze and compare the equivalent concepts of public health according to Ayurveda and contemporary sciences.
| Materials and Methods | | |
The concepts of epidemiology were critically analyzed in the purview of Janapadodhwansa chapter of Charaka Samhita. The related concepts from the contemporary sciences and advancements in the research were searched for and inculcated into the work through the robust search of literature from databases such as PubMed, AYUSH Portal, and Google Scholar. A comprehensive review comparing and critically analyzing the congruent information is compiled in the skeleton of the article.
| Observations | | |
Janapadodhwansaniya Chapter in the Light of Epidemiology
Janapadodhwansa is defined as a phenomenon in which a large population is inflicted with one particular disease irrespective of their Prakriti (~phenotype), Aahara (~dietary habits), Dehabala (~innate immunity and strength), Satmya (~behavioral habits and lifestyle), Sattva (~mental conditions), and Vayasa (~age group).[7] It is similar to the definition of epidemic or pandemic, where epidemic is a condition affecting a disproportionately large number of individuals within a population, community, or region at the same time.[8] Pandemic, however, is the condition occurring over a wide geographic area and an exceptionally high proportion of the population.[9]Janapadodhwansa has been defined as Janamara by Acharya Bhela[10] and Maraka in the text of Sushruta indicating the prevalence of epidemics in those times as well.[11] While opening the chapter, it is mentioned that the great teacher Punarvasu Atreya has assembled with his disciples at banks of the river Ganga in Panchal Pradesh (the present Northern India including the regions of Uttar Pradesh).[12] This description of location can be deried to understand the region specificity of diseases or occurrence of the endemic diseases in the area. Endemic disease is the one that is predominantly present in the population in the given area, e.g., chickenpox, malaria.[13] The discussion was held in the Gharamamaasa, i.e., in the Jyestha and Aashadha month 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, which even in the present era according to the epidemic calendar, witness the outbreak of various exanthemata, allergic conditions, and different types of fever annually.[14] This is a indicative of season specificity of emergence and transmission of many infectious diseases. Sushruta also states the Vyapanna Ritu (~unfavorable seasonal conditions) as the primary cause of Janapadodhwansa.[15] Seasonal variations whether gradual or transient can lead to disturbance in equilibrium of Doshas, thus affecting the health of population.
Understanding Epidemiological Triad—Application of Concept of Hetu
Hetu (~etiological factors) are the primary components of disease origin and pathogenesis. Hence the study of causes of disease origin is the most important step in epidemiology. In the present era, most of the public health is based on the working hypothesis that disease is caused due to the exposure to noxious factors in the external environment. The response of an individual to these changes or failure to cope up with disturbed environment and body equilibrium are the main causes of disease origin.[16] In the commentary on the starting verse in Janapadodhwansa chapter, Acharya Chakrapani has described two types of causes of origin of diseases, namely, Sadharana Hetu (~common etiological factors), which can produce diseases in almost all the beings termed as Bahujana Sadharana and Asadharana Hetu (~uncommon factors), which are personalized and differ from individual to individual.[17] Thus, the disrupted environment equilibrium will contribute to former while impaired body response to the etiological factors relates with the latter. This chapter deals with the Sadharana Hetu, which can be compared to the “epidemiological triad” that involves the external agent, susceptible host, and environment. The interaction of these three components always leads to disease causation in a large population and can be applied to both communicable and noncommunicable diseases.[18] The chapter explains the same concepts regarding the triad keeping the environmental factors such as Vata (~factors related to air and atmosphere), Jala (~factors related to water resources), Desha (~factors related to geographical conditions), and Kaala (~seasonal and climatic factors) in focus to cause epidemic situations.[19] According to epidemiology, these are the environmental factors affecting the contraction of disease, which include the geographic location, climatic factors, biological factors represented by plant-related and zoological factors (~Vriksha [flora], Mriga-Pakshi [fauna], etc.), and socioeconomic factors (~Janapada).[20]
As mentioned earlier, the seasonality of diseases is an important factor for the epidemic outbursts throughout the globe; thus, the Kaala factor does play an important role in disease manifestation. Geographical conditions are also important while considering the epidemiology, as the outbreak of some diseases is region-specific and their spread or progression also depends on the demographical and climatic conditions. It is helpful to understand the prevalence and incidence of diseases in the particular area. Ayurveda mainly describes three types of topographical conditions by dividing any region into three types, i.e., Jangala, Anupa, and Sadharana.[21]Jangala Desha (~dry land) has less biota, scarce water resources, more wind, and sunlight, whereas 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 and reduce the disease occurrence than those in Anupa. This concept can thus be correlated with medical topography.[22] It is the systematic surveying, mapping, charting, and description of specific geographical sites, with reference to the physical features that were presumed to influence health and disease. Some diseases are more prevalent in Northern Hemisphere, some in Southern, and 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 the disease.[23] Also, Shlipada (~filariasis) is generally prevalent in places where water stagnates for long time, which is cold in all the seasons of the year. Raichur district in Karnataka state (which has conditions similar to that of Anupa region) is the best example for the prevalence of Shlipada even today.[24] The individual environment-related factors responsible for the manifestation of epidemics according to Ayurveda can be summarized in [Table 1]. | Table 1: Vikriti Lakshana (~signs of vitiation) of factors of Janapadodhwansa with their reference in the present context
Click here to view |
Adharma (Behavioral Factors) as a Prime Cause for Epidemic Outbursts
Adharma can be described as not abiding to one’s prescribed duties and responsibilities. This can be associated with the human conduct and behavior responsible for the occurrence of diseases. This reflects on the social determinants of health. Researchers have proved that human behavior is equally responsible in the occurrence of epidemics as it results in overexploitation of natural resources leading to pollution of air, water, and soil, increase in the incidences of warfare (leads to human violence and destruction of communities), decreased social harmony (affects the social health), disturbance of ecosystems, and deterioration of universal health.[45] This aspect is important in the manifestation of noncommunicable diseases as well. Adharma is subdivided in metatypes such as Pragyaparadha, Shashtraprabhava, Rakshogana, and Abhishapa.[46] These can be derived in terms of Hetu of Janapadodhwansa in [Table 2]. | Table 2: Hetu of Janapadodhwansa in the purview of Adharma (~behavioral aspects)
Click here to view |
Jwara—Prime Linga (~Representative Symptom) of Janapadodhwansajanya Vyadhi
Jwara (~fever) is characterized as a condition affecting both physical and mental wellbeing. It is the chief disorder among all other diseases affecting every living being at the time of birth and death.[53],[54] It can be closely compared with flu or fever (pyrexia) where there is a rise in temperature and alteration in functioning of sense organs leading to intense fatigue and underperformance of routine tasks.[55] This might be the reason of mentioning the management of Jwara in Janapadodhwansa Adhyaya. Hence it is chosen for detailed discussion in the present work as well. Most of the epidemics related to infectious diseases are types of influenza or are almost always associated with fever.[56] The 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 Janapadodhwansa.
Management of Janapadodhwansajanya Vyadhi
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.[57],[58] This contributes to the basis of disaster management and organization of healthcare facilities during epidemics. The hospitals should be well prepared with all the emergency facilities to combat the health consequences of disasters.[59] The management of epidemic conditions according to both Charaka and Sushruta includes all the aspects of promotive and preventive health along with the principles of disaster management.[60],[61] The treatment and preventive aspects of epidemics in the purview of Ayurveda can be summarized in [Table 3].
| Discussion | | |
Janapadodhwansa represents the health crisis affecting substantial population instantaneously and over a period of time. It can thus include both the communicable and noncommunicable diseases that occur due to either personal or environmental factors. The occurrence of different Janapadodhwansajanya Vyadhi such as Kasa-Shwasa-Pratishyaya (respiratory infections), Chardi-Atisara (gastrointestinal infections such as vomiting and diarrhea), and primarily Jwara (pyrexia of any nature) represents the most pressing public health conditions. Fever was a presenting symptom in most of pandemics such as plague, cholera, and influenza.[51] The Janapadodhwansa chapter thus also focuses on the concepts of epidemiology and public health pertaining to Ayurveda. It underlines the importance of all the components of epidemiological triad mainly focusing on the components of environment and host. The generalized factors (Sadharana Hetu) are focused in the chapter to throw light upon the principles of community and public health. Hence while explaining the causes of origin and spread of diseases, the Desha and Kaala are given primary importance as they represent the region specificity and seasonality of the diseases respectively. Desha refers to the concept of medical topography that suggests the endemicity of particular diseases. Malaria is thus found to be endemic in tropical countries such as Africa and is less likely to spread at high altitude.[83] The four major factors involved in the occurrence of Janapadodhwansa are Vayu, Jala, Desha, and Kaala. These form the environmental aspect of the epidemiological triad.
The description of Vikrita Vayu indicates the alteration in the quality of air and blowing winds. Vishama Vayu indicates climate change that increases the vulnerability of the populations to climate-sensitive health risks such as injury, mortality, temperature-related illness (both hyperthermia and hypothermia), respiratory illnesses, zoonosis, vector borne diseases, malnutrition, communicable diseases, mental and psychosocial health, etc.[84] Both Atichala and Atikundalinam Vayu can be understood as fast-blowing winds, cyclones, hurricanes, or tornados that can result in public health emergencies such as storm-related mortality, injury, infectious diseases, and the impairment of mental wellbeing due to socioeconomic factors such as displacement, unemployment, disruption of ecosystems, etc.[85] The Atiparusha Vayu or overly dry air indicates the lack of humidity or excessive dryness in air contributing to the physical health-related symptoms such as 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.[30]Atisheeta Vayu or excessive cold air like experienced in air-conditioned environments also poses a threat to increase in respiratory infections.[86] Epidemics such as influenza have known to show a marked wintertime seasonality with over a 2–3-month period within the months of November and March, thus underlining the presence of cold air in atmosphere.[87]Atiabhishyandi, i.e., excessively humid air can intensify the heat and perspiration and trigger the respiratory conditions such as asthma and chronic obstructive pulmonary disorders (COPD).[28]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.[88] It can also result in excessive dehydration. Asatmya Gandha indicates the odor pollution, which is not only a determinant of environmental pollution but can also affect the physical health of community. It can result in the occurrence of symptoms such as wheezing, asthma, cough, headache, nausea, and even mental stress–related outcomes like mood changes.[89] The particulate matter or the presence of pollutants in air is a pressing problem because of the advent of globalization and industrialization. The exposure to particulate matter can lead to reduced lung function, development of lung diseases like COPD, occupational lung diseases, and even mortality.[90]
The factor of Jala mainly indicates water pollution, which endangers the health of community as drinking water and domestic use water are pivotal for sustenance. Dushita Jala (~impure water) also acts a carrier or cause of many epidemiological and endemic disorders. Most intestinal or enteric diseases are infectious and water borne. These are transmitted through fecal waste when the water is polluted by fecal matter itself.[91] Minamata Bay disease is an excellent example of the possible outbreak of severe disease through water pollution.[92] Many water-borne bacterial infections can result in the occurrence of diseases such as typhoid[93] (caused by Salmonella typhi), bacillary dysentery[94] (caused by Shigella), viral infections such as infectious hepatitis[95] (Hepatitis A), cholera[96] (caused by Vibrio), and protozoal infections[97] such as amebiasis, giardiasis, etc. Dushita Jalashaya indicates the 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 can result in the shortage of drinking water and poor quality of water, air quality, and the lack of hygiene.[98]Apreetikara Aapada Guna refers to the water sources having altered quality. The 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. Water-borne diseases resulting from the consumption of unhealthy drinking water poses a great threat to the high-risk population such as children, geriatric population, pregnant women, and those suffering from debilitating diseases. The water quality can be affected by the microbial content and the presence of impurities such as heavy metals, fecal matter, and other solvents making it unsafe for consumption.[99] This underlines the rationale of the Acharya for including the Jala as an important factor in Janapadodhwansa. This might also be a cause of mention of Ushnodaka in the same chapter. In the Janapadodhwansa chapter, the major line of treatment for the management of Amashayottha Vyadhi (diseases originating in Amashaya region) is Pachana (~ medications enhancing digestion), Vamana (~therapeutic emesis), and Apatarpana (catabolic or depleting procedures).[100]Ushnodaka helps in achieving all the above criteria. It is also indicated for the treatment of Jwara as it pacifies Vata and Kapha Dosha. It facilitates digestion and relieves anorexia as it possesses Deepana, Pachana properties. It suffices thirst when consumed even in small quantities. Its consumption is especially indicated in the management of respiratory conditions such as Kasa, Jwara, Shwasa, etc., which represent a majority of infectious diseases.[100],[101] Water is the elixir of life. No human can sustain without water irrespective of the presence or absence of disease condition. Thus, it rationalizes the description about the basic protocol regarding the consumption of water during epidemic-like conditions in the chapter.
Desha Dushti, the third factor leading to causation of Janapadodhwansa, can be understood as soil pollution that results from exposure to soil with an altered quality as there can be ingestion, inhalation, or dermal absorption of the pollutants present in the soil.[102] This factor is also affected by overcrowding, which leads to the lack of hygiene and sanitation increasing the risk of susceptibility of spread of infectious disorders. It can result in the lack of healthcare facilities or overburdening of healthcare facilities and the lack of sustainable development, further intensifying the environmental pollution. It is interesting to observe that while explaining the entity of Desha, all the factors like ecosystems, water resources, soil quality, air quality, biota, public behavior, and social circumstances have been considered, thus explaining the holistic approach of Ayurveda. Ecosystems have direct or indirect impact on health as they are major sources of food, water, supplies, and even livelihood for the population.[41] Disturbed ecosystems lead to the outbreak of various zoonotic diseases. For instance, the overabundance of vectors such as Makshika (~flies) and Mashaka (~mosquitoes) can relate to the spread of vector-borne diseases such as dengue and chikungunya. The natural disasters such as Ulka patana and Bhoomikapana indicate the emphasis of Acharya on the physical, mental, social, and economic burden caused by such mishaps on the millions of people increasing the incidence of morbidity and mortality due to communicable diseases as well.
Kala is the most important among 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 follow a cyclic or calendar pattern, and seasonal changes can lead to a sudden rise of epidemic outbreaks.[14] The recent climate change and seasonal variations have led to an increased occurrence of many diseases. WHO has also mentioned the increased incidence of malnutrition, malaria, diarrhea, and heat stress in coming decades as a result of climate change.[103]
After stating the components of environmental aspect, Acharya mentions the host-specific aspects applicable to the entire population under the umbrella of Adharma. The four factors, namely Pragyaparadha, Shashtraprabhava, Rakshogana, and Abhishapa, are social and behavioral determinants of health. These represent the quality of life of population in general and their impact on the public health.
This chapter describes Jwara as a representative of Janapadodhwansajanya Vyadhi as it is most prominent phenomena in any epidemic disorder. The prominence of fever in epidemics and its effective management are thus described to overcome the impact of epidemics.
The generalized principles for the management for the Janapadodhwansa include the measures for the promotion, preservation, and correction of both physical and mental health. The community programs that promote the avoidance of environmental pollution and climate and also cater to the sanitation of the public health systems must be implemented. The programs aimed toward facilitating the mental and social health of population should also be implemented. Also all the aspects of Ayurveda treatment such as Shodhana, Shamana, and Rasayana are mentioned for the management of condition. Vamana is important for the radical removal vitiated Dosha especially the Kapha Dosha and helps in pacifying the Jwara and Hrillasa (~nausea)-related conditions associated with the infection. Virechana also helps evacuate the vitiated Dosha through the feces and corrects the Agni vitiation. Basti controls the vitiated Vata and helps in the excretion of the toxins and fecal matter from the bowel region. Because of Nasya or nasal instillation, invading pathogens get adsorbed on the surface restricting their growth. Nasya is thus particularly useful in the treatment and prevention of respiratory tract infections. Snehana (~internal administration of ghee or oil) in the form of Go-Ghrita (~ghee), Tikta Ghrita can prove to be extremely effective in the management of Jwara-related conditions. Jwara involves the Avarodha (~obstruction) of Swedavaha Strotas (~ body channels carrying sweat); hence, it will help expel the toxins by inducing the process of sudation. The carminative therapy plays a key role at almost every step in the management as the maintenance of Agni function is of prime importance in the prevention of any disease. Dhoomapana is a localized treatment where the particulate matter in medicated smoke has antimicrobial activity and maintains the integrity of respiratory tract.[104]Gandusha, Kavala, and Dantapavana act as mechanical barriers by avoiding the entry of pathogens through the buccal cavity. Sharira Parimarjana and Snana measures contribute to the cleansing of the body surfaces and also includes Hasta and Mukha Prakshalana, i.e., hand and feet sanitization to prevent the spread of disease. The Rasayana Chikitsa forms the backbone of treatment as it is pivotal in enhancing the immunity for resisting the disease occurrence. Different drugs acting on Pranavaha, Rasavaha, and Annavaha Strotas can thus be implemented in mainstream for the management of epidemics. The use of various formulations such as Chyavanaprasha Rasayana, Bramha Rasayana, Pippali Rasayana, Amalaki Rasayana, etc. are popular in a clinical scenario for the maintenance of health during pandemic conditions. Other nonpharmacological and counseling-based approaches such as Sadvritta and behavioral attributes such as Satyabhashana, Bhootadaya, etc. 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. Sadvritta emphasizes on the spread and containment of the infectious diseases and their mode of transmission.[105] Sexual contact is also an important route of transmission for STD, making it extremely crucial to follow safe and balanced sexual life during epidemic conditions. The recreational measures reinstate the healthy daily routine of population focusing on the aspects of social and mental harmony, diet, and lifestyle measures. The pandemics often restrict the outdoor and interpersonal contact leading to diminished mental and social health, and the research shows that outdoor activities and physical exercises show positive impact on wellbeing.[106]
| Conclusion | | |
Janapadodhwansa Adhyaya explained in Charaka Samhita is the testimony of the contribution of Ayurveda in the field of epidemiology and public health. The description of the four major etiological factors in the causation of the epidemic and pandemic diseases coincides with the contemporary approach of disease spread in the light of epidemiological triad especially focusing on the component of environment. The impact of social, behavioral, and psychological aspects on the occurrence of diseases on a larger population is highlighted by the description of Adharma. Jwara or fever is described as a representative of all epidemiological disorders because of its high occurrence. The management of such conditions is rightfully given in terms of Shodhana, Shamana, Rasayana, Sadvritta Palana, etc., which focuses on the promotion of both physical and mental health.
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Conflicts of interest
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[Table 1], [Table 2], [Table 3]
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