Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
There’s a situation referred to as as ‘Janu Vishlesha’ talked about amongst Vata Nanatmaja Rogas – particular and particular problems attributable to aggravation of ‘solely vata’. Completely there are eighty nanatmaja rogas of vata. Janu Vishlesha is one amongst them.
Phrase Which means
The phrase Janu Vishlesha is made up of two phrases – Janu and Vishlesha
Janu = Knee joint
Vishlesha means feeling of looseness, which additionally means instability. Different meanings of the time period vishlesha are –
– Separation, separate from
– Falling asunder / aside
– Dissolution – Destruction by breaking down
– Disjunction – lack of consistency
– Trigger to be disunited
Causes for Janu Vishlesha
1. Abhyantara Nidana: Intrinsic Causes
Kapha issue: Sandhi Bandha – binding the joints and holding them built-in is likely one of the chief features of balanced kapha. Kapha lubricates the bony joints and retains them moist and versatile. That is led to by the unctuous, secure and easy qualities of kapha. The actions are straightforward on the joints because of the presence of shleshaka kapha – subtype of kapha, in balanced proportions. The joints give manner and develop into unfastened when this kapha decreases. Kapha depleting meals and actions will hit arduous on the integrity of joints. Then again, kapha depletion will result in a rise of vata. This can additional injury the joints by depleting the lubricating substances that are pure to these joints and convey about instability therein. When these occasions occur in knee joints, it might result in janu vishlesha.
Vata issue: Vata, in its balanced and serene state is answerable for correct actions on the joints and locomotion. When vata will get aggravated within the joints it destroys kapha – the protecting buffer, moistness and lubrication of these joints, resulting from its dry and tough qualities. The causes embody vata aggravating meals and actions. Sandhi vishlesha is attributable to vata aggravation within the knee joints.
Notice: Vata and kapha are antagonistic doshas. Enhance of 1 dosha would lower the opposite. The opposite manner can also be true. So, vata growing meals and actions by default would deplete kapha. Equally, kapha depleting meals and actions would enhance vata.
Pathogenesis of Janu Vishlesha, Kapha Kshaya and Vata Vriddhi hyperlink
Integrity and lubrication of any joint together with Janu Sandhi – knee joint is led to by balanced kapha situated within the joints, primarily shleshaka kapha – joint particular subtype of kapha. The actions and suppleness and involvement of joints in locomotion is led to by balanced vata. So long as the connection of kapha and vata concerned in joint integrity and functioning is balanced, the joints are secure and wholesome. When there’s a proportional imbalance of those two doshas, particularly kapha lower adopted by vata enhance or vice versa, there happens laxity or feeling of looseness within the joints and a really feel of ‘joints giving manner’. That is referred to as ‘Janu Vishlesha’.
Medo Upadhatu issue
Snayu – ligaments (and tendons) and Sandhi (joints) are the upadhatus – sub-tissues of medo dhatu (fats tissue). Each these parts are affected by knee instability. So, one ought to preserve a verify on the physique weight. Being obese or overweight could also be a danger issue and should trigger extreme strain on the ligaments across the knee joint and the joint itself in order to trigger instability and painful circumstances of knee joint.
2. Bahya Nidana – Exterior Causes
Damage issue – vata and rakta aggravation
Tears and harm to the ligaments in and across the knee joint is the primary trigger for janu vishlesha vis-à-vis instability of the knee. Damage is an extrinsic issue which later results in aggravation of vata. Damage additionally causes aggravation of rakta.
Ati Vyayama – as nidana
Ati Vyayama – extreme workout routines and bodily actions past one’s capability is the chief reason for trauma, compression and vata aggravation within the knee joint which can in flip result in janu vishlesha.
3. Bahya-Abhyantara Nidana – Exterior and Inside Causes
Majjavaha Srotas issue
Asthi – bones and Sandhi – joints are the roots of the majjavaha srotas – channels transporting / or answerable for formation and upkeep of bone marrow. Utpesha – crushing accidents, abhighata – accident, trauma and prapeedana – compression are the necessary causes for contamination of majjavaha srotas. These are additionally the chief causative components for knee instability. Viruddha Ahara – consumption in extra of mutually incompatible meals and Ati Abhishyandana – being full of moist parts / kapha are the intrinsic causes for contamination of majjavaha srotaas. A mix of each these components concerned within the pathogenesis occurring within the bones and joints involving the knee joint could trigger ache and instability associated to janu vishlesha vis-à-vis knee joint / joints.
Vatarakta Hyperlink
Within the illness vatarakta, vata and rakta are individually aggravated resulting from their particular person aggravating components. Within the later a part of pathogenesis, vata and rakta mutually afflict one another and trigger the illness vatarakta. This situation is attributable to a mix of intrinsic and extrinsic components as defined within the nidana of the illness. Damage is the frequent extrinsic issue for aggravation of each vata and rakta. When harm is the frequent issue aggravating vata and rakta together with their particular person aggravating components, they could come into the best way of one another and trigger a situation referred to as vatarakta. This situation could cause painful circumstances of the joints. When this pathogenesis happens within the knee joint / joints, it might trigger joint instability together with ache and different signs of vatarakta. On this situation, knee joint won’t be the one joint bothered.
Sandhi Vikriti: Joint ailments and deformities
Many joint problems, primarily these that are continual, would trigger janu vishlesha – knee instability in the long term. They embody –
Janu Sandhigata Vata – popularly in comparison with osteoarthritis, additionally impacts the knee joints and is likely one of the problems which could trigger knee instability i.e. janu vishlesha in the long term. It is a vata dysfunction whereby aggravated vata localized within the knee joint causes sandhi nasha – destruction of the joint together with the destruction of ligaments, tendons, sinews and your entire joint inflicting janu vishlesha. Shula – ache and Atopa – sounds / swelling within the joint are the opposite signs. There may be additionally problem in actions on the knee joint, primarily prasarana – extension and akunchana – flexion of the knee joint.
Amavata – usually correlated with rheumatoid arthritis, is a illness attributable to a vicious mixture of ama and vata. It’s a systemic illness which begins from the intestine and ends by affecting the musculoskeletal system. Among the many a number of joints it impacts, the knee joint can also be the one. Other than ache and swelling of the joint, it might additionally trigger janu vishlesha.
Vatarakta – usually correlated with gouty arthritis, can also be a systemic dysfunction which in the end of time afflicts the joints. The pathogenesis of vatarakta has been defined above. It is likely one of the causes for Janu Vishlesha.
Although ‘janu vishlesha’ has not been instantly talked about among the many signs of any of those circumstances, the situation occurring within the course of of those ailments may be inferred by way of their pathogenesis and in addition from the attitude that vata is concerned in all these ailments and all of them do have an effect on the knee joint.
Trendy Perspective of Janu Vishlesha
Indicators and signs of knee instability v/s Janu Vishlesha
Instability of the knee joint is the primary symptom of ‘knee instability’. Janu Vishlesha too means the identical.
Indicators and signs of ‘knee instability’ are relatable to the signs of vata aggravation.
Popping sound, sudden and extreme ache, swelling, incapacity to bear weight and sensation of joint looseness or instability – that are the indicators and signs of ‘knee instability’, that are additionally the indicators and signs of ‘vata aggravation’. All these signs are additionally half and parcel of janu vishlesha.
The identical are additionally the signs of ‘sandhigata vata’.
‘Janu Vishlesha’ may be correlated with a situation referred to as ‘Knee Instability’ defined in trendy medication. The signs of knee instability which observe harm are attributable to aggravated vata.
Remedy Ideas of Janu Vishlesha
Nidana Parivarjana – Since Janu Vishlesha is principally attributable to vata aggravation, all etiological components resulting in it shall be stored away. Primarily, one needs to be cautious about their nature of labor particularly whether it is ‘harm susceptible’ work and in addition extreme and vigorous bodily actions, together with sporting. Any harm or insult taking place to the knee joint needs to be instantly addressed with appropriate interventions.
Vata and Kapha balancing – The important thing to deal with Janu Vishlesha might be to deliver vata and / or kapha to a state of stability and in addition to result in their relative stability.
Since vata is the chief dosha concerned within the causation of this situation and can also be a vata nanatmaja roga, the medicines, therapies and dietetic protocols meant to deal with vata rogas are additionally relevant right here.
Coping with Medo Vriddhi – Fats enhance, weight problems or being obese would impart excessive strain on the knee joint because it is a crucial weight bearing joint and trigger injury to the joint, and associated constructions i.e. muscle tissue, bones, ligaments, tendons and blood vessels get injured and consequently broken. Weight administration is the important thing technique on this situation.
Coping with sandhi vikriti
Illnesses like vatarakta, sandhigata vata or amavata afflicting the knee joint shall be successfully dealt with with appropriate interventions. This can verify the additional injury to the joint. Additional the knee joint could also be strengthened by balya and brimhana therapies and medicines.
Coping with asthivha and majjavaha sroto dushti and gata vata
Contamination or injury to channels associated to asthi – bones and majja – bone marrow could cause janu vishlesha. Equally, it might even be attributable to circumstances like asthigata vata or majjagata vata – aggravated vata localized in bones or bone marrow respectively and shall be dealt accordingly.
Balya, Brimhana and Rasayana Chikitsa
To strengthen the knee joint and to reinforce stability therein, balya – strengthening, brimhana – bulk selling and rasayana – anti-ageing / rejuvenation medicines and meals needs to be administered.
1. Bahya Chikitsa – Exterior therapies
Beneath talked about exterior therapies might be useful in strengthening the knee joint and in addition in lowering the signs of sandhi vishlesha and in addition would stability the vitiated vata.
– Abhyanga – therapeutic massage with natural / vata mitigating oils
– Swedana – sudation – patra pinda sweda, shashtika shali pinda sweda
– Swedana – sudation – patra pinda sweda, shashtika shali pinda sweda
– Janu Vasti – oil pooling across the bothered knee joint / joints
2. Abhyantara Chikitsa – Inside medicines
The inner interventions for janu vishlesha are as under talked about –
– Sneha pana / Snehana – oral consumption of medicated fat, primarily ghee or ghee and oil – like Guggulutiktaka Ghrta, Ashwagandha Ghrta and so forth.
– Vasti – enema with medicated ghee / oil or each – utilizing the identical medicines talked about in Sneha pana
Helpful formulations
– Maharasnadi Kashayam
– Sahacharadi Kashayam
– Dhanwantaram Kashayam
– Rasnasaptaka Kashayam
– Guggulutiktakam Ghrtam
– Ksheerabala Taila
– Yogaraja Guggulu
Helpful Yoga Postures
– Utkatasana – Chair pose
– Virabhadrasana II – Warrior II Pose
– Ardhachandrasana – Half moon pose
– Utkata Konasana – Goddess Pose
– Prapadasana – Tip Toe Pose
– Ardha Purvottanasana – Reverse Desk High
– Balasana – Youngster’s Pose
– Dandasana – Workers / Stiff Pose
– Sethu Bandhasana – Bridge Pose
– Janu Shirsasanan – Head to knee ahead bend
– Utthitha Parsvakonasanan – Prolonged aspect angle
– Malasana – Garland Pose
– Paschimottanasana – Seated Ahead Bend
Trendy Correlation
Janu Vishlesha may be correlated with a situation defined in trendy medication named ‘Instability of Knee Joint’, by that means and in addition by related scientific presentation.
Knee instability is usually attributable to accidents or problems affecting the ligaments throughout the knee joint. It presents as a sensation of ‘giving out’ or ‘buckling’ of the knee joint, primarily when the joint is subjected to strain. It occurs when the ligaments across the knee joint fail to carry the bones making the knee joint in place securely. This ultimately leads to a wobbly feeling whereas bearing weight on the knees. Tears of ACL, MCL and PCL majorly contribute to the knee instability. Other than tears and accidents, it might even be attributable to numerous actions associated to life-style – like twisting, leaping or sudden stops and so forth. Knee osteoarthritis, patellar instability, knee strains and sprains, gout, an infection of knee joint, meniscus tear or bursitis may trigger knee instability.
The chief signs of knee instability embody loud popping or snapping sounds within the joint, sudden and extreme ache manifestation, feeling of looseness of the knee joint, incapacity to bear the burden on the affected joint and swelling.
Associated Studying – Knee Instability
