Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

There’s a situation known 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 clean qualities of kapha. The actions are straightforward on the joints as a result of presence of shleshaka kapha – subtype of kapha, in balanced proportions. The joints give method and turn into free when this kapha decreases. Kapha depleting meals and actions will hit onerous on the integrity of joints. Then again, kapha depletion will result in a rise of vata. This may 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, on account of its dry and tough qualities. The causes embrace 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 method can also be true. So, vata rising 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 adaptability 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 method’. That is known 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 maintain a test on the physique weight. Being obese or overweight could also be a threat issue and will 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 damage to the ligaments in and across the knee joint is the principle 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 behind 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 essential causes for contamination of majjavaha srotas. These are additionally the chief causative elements for knee instability. Viruddha Ahara – consumption in extra of mutually incompatible meals and Ati Abhishyandana – being stuffed with moist parts / kapha are the intrinsic causes for contamination of majjavaha srotaas. A mixture of each these elements concerned within the pathogenesis occurring within the bones and joints involving the knee joint might trigger ache and instability associated to janu vishlesha vis-à-vis knee joint / joints.

Within the illness vatarakta, vata and rakta are individually aggravated on account of their particular person aggravating elements. 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 combination of intrinsic and extrinsic elements as defined within the nidana of the illness. Damage is the widespread extrinsic issue for aggravation of each vata and rakta. When damage is the widespread issue aggravating vata and rakta together with their particular person aggravating elements, they might come into the way in which of one another and trigger a situation known 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 troubled.

Sandhi Vikriti: Joint illnesses and deformities

Many joint problems, primarily these that are persistent, would trigger janu vishlesha – knee instability in the long term. They embrace –

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. This can be 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 the whole 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. Aside from 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 immediately talked about among the many signs of any of those circumstances, the situation occurring within the course of of those illnesses will be inferred by their pathogenesis and likewise from the attitude that vata is concerned in all these illnesses 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 principle 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’ will be correlated with a situation known as ‘Knee Instability’ defined in fashionable drugs. The signs of knee instability which observe damage are attributable to aggravated vata.

Remedy Rules of Janu Vishlesha

Nidana Parivarjana – Since Janu Vishlesha is principally attributable to vata aggravation, all etiological elements resulting in it shall be saved away. Primarily, one must be cautious about their nature of labor particularly whether it is ‘damage inclined’ work and likewise extreme and vigorous bodily actions, together with sporting. Any damage or insult occurring to the knee joint must 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 likewise 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 may test 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 must be administered.

1. Bahya Chikitsa – Exterior therapies

Under talked about exterior therapies might be useful in strengthening the knee joint and likewise in decreasing the signs of sandhi vishlesha and likewise 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 troubled 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 on.
–         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 – Baby’s Pose
–         Dandasana – Employees / Stiff Pose
–         Sethu Bandhasana – Bridge Pose
–         Janu Shirsasanan – Head to knee ahead bend
–         Utthitha Parsvakonasanan – Prolonged facet angle
–         Malasana – Garland Pose
–         Paschimottanasana – Seated Ahead Bend

Trendy Correlation

Janu Vishlesha will be correlated with a situation defined in fashionable drugs named ‘Instability of Knee Joint’, by that means and likewise by related scientific presentation.

Knee instability is generally attributable to accidents or problems affecting the ligaments inside 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 finally leads to a wobbly feeling whereas bearing weight on the knees. Tears of ACL, MCL and PCL majorly contribute to the knee instability. Aside from tears and accidents, it might even be attributable to numerous actions associated to life-style – like twisting, leaping or sudden stops and so on. 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 embrace loud popping or snapping sounds within the joint, sudden and extreme ache manifestation, feeling of looseness of the knee joint, incapacity to bear the load on the affected joint and swelling.

Associated Studying – Knee Instability

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