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A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA, ANKUR SINGHAL , SEPTEMBER 2007, DEPARTMENT OF POST GRADUATE STUDIES IN KAYA CHIKITSA, …

A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA, ANKUR SINGHAL , SEPTEMBER 2007, DEPARTMENT OF POST GRADUATE STUDIES IN KAYA CHIKITSA, B.N.M.E.T’S SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTRE, BIJAPUR.


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  • 1. “A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA” BY Dr. ANKUR SINGHAL DISSERTATION SUBMITTED TO THE RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. IN THE PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF MEDICINE (Ayurveda) IN KAYA CHIKITSA UNDER THE GUIDANCE OF Dr. TAMAGOND B.S. M.D. (AYU) Prof. & H.O.D (Kayachikitsa) Dr. B.N.M.E. Trust’s Shri Mallikarjun Swamiji Post Graduate and Research Centre, Bijapur- 586101. DEPARTMENT OF POST GRADUATE STUDIES IN KAYA CHIKITSA, B.N.M.E.T’S SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTRE, BIJAPUR. SEPTEMBER 2007
  • 2. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. DECLARATION BY THE CANDIDATEI, hereby declare that this dissertation / thesis entitled“A COMPARATIVECLINICAL STUDY ON JARA WITH RESPECT TO AGEINGPROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA”is a bonafide and genuine research work carried out by me under the guidance ofDr. TAMAGOND B.S. M.D. (AYU) Professor and H.O.D, Dept. of Kaya chikitsa,Shri Mallikarjuna Swamiji Post Graduate And Research Centre, Bijapur.Date:Place: Bijapur. Dr.ANKUR SINGHAL
  • 3. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE Dr. B. N. M. E. T’s SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTRE, BIJAPUR.DEPARTMENT OF POST GRADUATE STUDIES IN KAYA CHIKITSA CERTIFICATE BY THE GUIDEThis is to certify that the dissertation entitled “A COMPARATIVE CLINICALSTUDY ON JARA WITH RESPECT TO AGEING PROCESS WITHAMALAKI AND ASHWAGANDHA CHURNA”is a bonafide research workcarried out by Dr. ANKUR SINGHAL in the partial fulfillment of the requirementfor the degree of M.D. (Ayurveda). SignatureDate: Dr. TAMAGOND B.S. M.D. (AYU)Place: Bijapur. Professor and H.O.D. Dept. of Kaya Chikitsa, Shri Mallikarjuna Swamiji Post Graduate And Research Centre, Bijapur.
  • 4. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE Dr. B. N. M. E. T’s SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTRE, BIJAPUR.DEPARTMENT OF POST GRADUATE STUDIES IN KAYA CHIKITSA ENDORSEMENT BY THE H.O.D. AND PRINCIPAL/HEAD OF THE INSTITUTIONThis is to certify that the dissertation entitled “A COMPARATIVE CLINICALSTUDY ON JARA WITH RESPECT TO AGEING PROCESS WITHAMALAKI AND ASHWAGANDHA CHURNA” is a bonafide research workdone by Dr. ANKUR SINGHAL under the guidance of Dr. B.S.TAMAGONDAM.D (Ayu) Prof. and H.O.D, Dept. of Kaya chikitsa, Shri Mallikarjuna Swamiji PostGraduate and Research Centre, Bijapur.Seal and Signature of H.O.D Seal and Signature of PrincipalDr. B.S.TAMAGONDA M.D (Ayu) Dr. R.N.GENNUR M.D (Ayu)Date : Date :Place : Bijapur Place : Bijapur
  • 5. COPYRIGHT DECLARATION BY THE CANDIDATE I here by declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate this dissertation/thesis in print or electronic format for academic/research purpose.Date:Place: Bijapur. Dr. ANKUR SINGHAL© Rajiv Gandhi University of Health Sciences, Karnataka.
  • 6. i ACKNOWLEDGEMENT There is no ‘I’ in the word ‘TEAM’One of the beautiful quotations which I would like to remind myself after completion ofthis dissertation work. On the eve of completion of the dissertation, I bow my head to the great almightyand my grandparents and parents who are always showering, blessing on me and withoutwhose blessing, I would not have been able to attain this stage in my life. I would like to seize this opportunity to express my gratitude first towards ourrespective chairman Dr. K.B. Nagur M.D. (AYU) and the management committee members ofDr. B.N.M.E. Trust for providing all the requisite facilities to carry out this work. I would like to offer my respectful thanks to the Principal Dr. R.N. Gennur M.D.(AYU) for his constant support throughout my curriculum. It has been my privilege to work under renowned, genuine guidance ofDr. B.S. Tamagond M.D. (AYU) whose tremendous insights into the Ayurveda concepts havemade significant contributions to this dissertation work. I offer my respectful thanks to Dr. S.P. Managaoli M.D. (AYU) whose support andguidelines encouraged me in every step in this dissertation work. I express my profound gratitude to DR. B.G. Patil for his guidance and help. I acknowledge the rent less support, care confirmed by DR. Anita Patil M.D. (AYU)and Dr. P.B. Savalgi M.D. (AYU). The completion of this dissertation in time has a lot to dowith their constant support. I cant forget to express my in debtness towards Dr. P.V. Savanur , Dr. J.C.Huddar. Dr. C.S. Hiremath , Dr. Girish Bagli and Dr. Mulla for their timely support ,valuable guideline , care and encouragement in every step of this dissertation work.
  • 7. ii I am thankful to Sri Tapashetti MSc (Stat.) for his timely guidance and suggestions inthe statistical analysis of data. This endeavor is a collection effort of several of my colleagues who almost slavedthrough the gestation of the work, their names are Dr. Amit, Dr. Sandeep ,Dr. Rugavedi,Dr.Totad, Dr. Vasanta , Dr. Sudhir, Dr. Jitendra , Dr. Shakil. I am what I am, because of my close friend Dr. Sunil Nair without his caring,helping nature, cooperation this work could not be possible . I take this privilege to thank my friend Mr. Amrut for kind support and helpingme in computer work. I thank Sri. R.G.Dolli for the official work and also the non teaching staff andlibrary staff too, of Dr. B.N.M.E. Trust’s Ayurvedic Medical College and Post GraduateResearch Centre, Bijapur for their timely help. I am greatful to my brother Ankit Singhal and sister Aastha Singhal for theirprofound and unending love. Last but not the least my humble thanks towards my patients without whosecooperation this work could not be completed at all. I offer my sincere apologies to omissions in the above list and appeal to considerthem as fatuous.Date:Place: Bijapur Dr. Ankur Singhal
  • 8. iii ABBREVIATIONSA.H. ASTANGA HRIDAYAA.S. ASTANGA SANGRAHAA.T. AFTER TRATMENTB.T. BEFORE TREATMENTB.P. BHAVAPRAKASH NIGHANTUB.R. BHAISAJYARATNAVALICH CHARAKACS CHARAKA SAMHITAHS HIGHLY SIGNIFICANTKS KASHYAPA SAMHITAMN MADHAVA NIDANANS NON SIGNIFICANTFU FOLLOW UPRRS RASARATNASAMUCCHAYAS SIGNIFICANTSHS SHARANGDHARA SAMHITAS.S. SUSHRUTA SAMHITAVAG VAGBHATAYR YOGARATNAKARA
  • 9. iv ABSTRACT ‘The test of any civilization is the measure of consideration and care Which it gives to its weaker members’ No one knows when old age begins. The “biological age” of a person is notidentical with his “Chronological age”. It is said that nobody grows old merely byliving a certain number of years. Years wrinkle the skin, but worry, doubt, fearanxiety and self distrust wrinkle the soul. While ageing merely stands for growingold, senescence is an experiment used for the deterioration in the vitality or thelowering of the biological efficiency that accompanies aging. With the passage oftime, certain changes take place in an organism which are for the most partdeleterious and eventually lead to the death of the organism.Introduction With improving health care, our average life expectancy has risen from 57 in 1990to 65 today. In the next two decades, India will also be home to the world’s second citizens,is expected to touch 198 millions in 2030.There are eight millions aged over 80, 29 millions70 plus and 77 millions above 60.Census shows that one out of every two elderly suffers from at least alone chronic diseasethat requires lifelong medication. Nearly 50% report arthritis, 40% hypertension, 30%hearing impairment , 40% defective vision , 10%diabetes , 89 out of every 1000 arementally ill.Ayurveda has considered Jara as one of the branch among eight branches of Ayurveda.Classics have mentioned different categories of drugs including Vayasthapana, Jeevneeya,and Rasayana drugs. Amalaki and Ashwagandha are one among them, which are knownfor their peculiar qualities. The study work entitled ‘A Comparative Clinical study on Jaraw.r.t. Aging process with Amalaki and Ashwagandha Churna’ with the aim to achieve thegoal of healthy aging in coming years.
  • 10. vReviewReview of literature consists of three parts Classical review, Modern review and Drugreview. This includes Definition, Synonyms, Types of Aging, Etiological factors, Signs andsymptoms and various theories which have been described in favour of process of aging.Materials and Methods It includes the drugs Amalaki and Ashwagandha Churna 10gm in divided dose forsixty days and the instruments used for clinical assessment such as sphygmomanometer,clinical hammer etc. The study taken was comparative clinical single blind study.Parameters of study have been the signs and symptoms of Jara selected for study. Thirtypersons were selected accordingly and divided into two groups of 15 persons each. Totalstudy period was ninety days, 60 days treatment and 30 days post treatment follow up.Clinical data was collected before treatment after treatment and at follow up, according tothe Case Proforma specially prepared for this study.ObservationsObservations include generalized observation such as age, sex, habitat etc. and individualobservation according to parameters of assessment of signs and symptoms such asAgnimandya , Malabaddhata etc.ResultsThe overall results in the trial Group B was significantly better than the trial Group A.Group A showed significant results for very few parameters as compare to other group.InterpretationAshwagandha Churna showed good results for almost all the parameters and helped toincrease the well being of the old age person. So it can be interpretated that Ashwagandhahas got significant properties in treating aging elements.KEY WORDS - JARA, AGEING, AMALAKI, ASHWAGANDHA
  • 11. vi CONTENTS CONTENTS PAGE NO. Acknowledgment i-ii Abbreviation iii Abstract iv-v List of Tables vii List of Graphs viii I. INTRODUCTION 1-3 II. OBJECTIVES 4 III. REVIEW OF LITERATURE 5-24 IV. MATERIALS AND METHODS 25-31 V. OBSERVATION AND RESULTS 32-68 VI. DISCUSSION 69-90VII. CONCLUSION 91VIII. FEW WORDS 92 IX. RECOMMENDATIONS FOR FURTHER STUDY 93 X. SUMMARY 94-95 XI. BIBLIOGRAPHY 96-99XII. ANNEXURE a. Classical References I-II b. Photographs III c. Case Proforma IV-VIII
  • 12. vii LIST OF TABLESNo TABLE TITLE Page no.1. CLASSIFICATION OF VAYA ACCORDING TO AYURVEDIC 7 ACHARYAS2. DECLINING OF SHAREER BHAVA AT VARIOUS DECADES OF LIFE. 93. FEATURES OF AGEING ACCORDING TO AYURVEDIC CLASSICS 124. SELCTED AGE RELATED CHANGES AND THEIR CONSEQUENCES 175. DISTRIBUTION OF PERSONS ACCORDING TO AGE 336. DISTRIBUTION OF PERSONS ACCORDING TO SEX 347. DISTRIBUTION OF PERSONS ACCORDING TO RELIGION 358. DISTRIBUTION OF PERSONS ACCORDING TO OCCUPATION 369. DISTRIBUTION OF PERSONS ACCORDING TO SOCIO-ECONOMIC 37 STATUS10. DISTRIBUTION OF PERSONS ACCORDING TO FOOD HABIT 3811. DISTRIBUTION OF PERSONS ACCORDING TO HABITS 3912. DISTRIBUTION OF PERSONS ACCORDING TO PRAKRITI 40 PRADHANATA13. DISTRIBUTION OF PERSONS ACCORDING TO SYSTOLIC BLOOD 41 PRESSURE14. DISTRIBUTION OF PERSONS ACCORDING TO DIASTOLIC BLOOD 42 PRESSURE15. DISTRIBUTION OF PERSONS ACCORDING TO WEIGHT 4316. DISTRIBUTION OF PERSONS ACCORDING TO HAEMOGLOBIN 4417. DISTRIBUTION OF PERSONS ACCORDING TO VISUAL ACUITY (RT.) 4518. DISTRIBUTION OF PERSONS ACCORDING TO VISUAL ACUITY (LT.) 4619. DISTRIBUTION OF PATIENTS BASED ON AGNI MANDYA BEFORE 47 TREATMENT20. DISTRIBUTION OF PATIENTS BASED ON MALABADDHATA BEFORE 47 TREATMENT21. DISTRIBUTION OF PATIENTS BASED ON INDRIYA KSHAYA BEFORE 48 TREATMENT22. DISTRIBUTION OF PATIENTS BASED ON NIDRANASHA BEFORE 48 TREATMENT23. DISTRIBUTION OF PATIENTS BASED ON BALAKSHAYA BEFORE 49 TREATMENT24. DISTRIBUTION OF PATIENTS BASED ON GRAHANA KSHAYA 49 BEFORE TREATMENT25. DISTRIBUTION OF PATIENTS BASED ON SHWASA BEFORE 50 TREATMENT26. DISTRIBUTION OF PATIENTS BASED ON SARVAKRIYA 50 ASWASAMARTH BEFORE TREATMENT27. RESPONSE OF TREATMENT FOR INDIVIDUAL GROUP 52 AFTER TREATMENT28. RESPONSE OF TREATMENT FOR INDIVIDUAL GROUP 55 AT POST TREATMENT FOLLOW UP29. TABLE SHOWING THE STATISTICAL RESULTS OF GROUP-A 58-5930. TABLE SHOWING THE STATISTICAL RESULTS OF GROUP-B 60-61
  • 13. viii LIST OF GRAPHSG.No TITLE OF GRAPH P.No. 1. DISTRIBUTION OF PERSONS ACCORDING TO AGE 33 2. DISTRIBUTION OF PERSONS ACCORDING TO SEX 34 3. DISTRIBUTION OF PERSONS ACCORDING TO RELIGION 35 4. DISTRIBUTION OF PERSONS ACCORDING TO OCCUPATION 36 5. DISTRIBUTION OF PERSONS ACCORDING TO SOCIOECONOMIC STATUS 37 6. DISTRIBUTION OF PERSONS ACCORDING TO FOOD HABIT 38 7. DISTRIBUTION OF PERSONS ACCORDING TO HABITS 39 8. DISTRIBUTION OF PERSONS ACCORDING TO PRAKRITI PRADHANATA 40 9. DISTRIBUTION OF PERSONS ACCORDING TO SYS. BLOOD PRESSURE 41 10. DISTRIBUTION OF PERSONS ACCORDING TO DIA. BLOOD PRESSURE 42 11. DISTRIBUTION OF PERSONS ACCORDING TO WEIGHT 43 12. DISTRIBUTION OF PERSONS ACCORDING TO HAEMOGLOBIN 44 13. DISTRIBUTION OF PERSONS ACCORDING TO VISUAL ACUITY(RT.) 45 14. DISTRIBUTION OF PERSONS ACCORDING TO VISUAL ACUITY (LT.) 46 15. DISTRIBUTION OF PATIENTS BASED ON AGNI MANDYA B.T. 47 16. DISTRIBUTION OF PATIENTS BASED ON MALABADDHATA B.T. 47 17. DISTRIBUTION OF PATIENTS BASED ON INDRIYA KSHAYA B.T. 48 18. DISTRIBUTION OF PATIENTS BASED ON NIDRANASHA B.T. 48 19. DISTRIBUTION OF PATIENTS BASED ON BALAKSHAYA B.T. 49 20. DISTRIBUTION OF PATIENTS BASED ON GRAHANA KSHAYA B.T. 49 21. DISTRIBUTION OF PATIENTS BASED ON SHWASA B.T. 50 22. DISTRIBUTION OF PATIENTS BASED ON SARVAKRIYA 50 ASWASAMARTH BEFORE TREATMENT 23. RESPONSE ON AGNIMANDYA AFTER TREATMENT 62 24. RESPONSE ON AGNIMANDYA AT FOLLOW UP 62 25. RESPONSE ON MALABADDHATA AFTER TREATMENT 62 26. RESPONSE ON MALABADDHATA AT FOLLOW UP 62 27. RESPONSE ON INDRIYA KSAHYA AFTER TREATMENT 63 28. RESPONSE ON INDRIYA KSAHYA AT FOLLOW UP 63 29. RESPONSE ON NIDRA NASHA AFTER TREATMENT 63 30. RESPONSE ON NIDRA NASHA AT FOLLOW UP 63 31. RESPONSE ON BALA KSHAYA AFTER TREATMENT 64 32. RESPONSE ON BALA KSHAYA AT FOLLOW UP 64 33. RESPONSE ON GRAHANA KSHAYA AFTER TREATMENT 64 34. RESPONSE ON GRAHANA KSHAYA AT FOLLOW UP 64 35. RESPONSE ON SHWASA AFTER TREATMENT 65 36. RESPONSE ON SHWASA AT FOLLOW UP 65 37. RESPONSE ON SARVAKRIYA ASWASAMARTH AFTER TREATMENT 65 38. RESPONSE ON SARVAKRIYA ASWASAMARTH AT FOLLOW UP 65 39. RESPONSE ON SYSTOLIC BLOOD PRESSURE AFTER TREATMENT 66 40. RESPONSE ON SYSTOLIC BLOOD PRESSURE AT FOLLOW UP 66 41. RESPONSE ON DIASTOLIC BLOOD PRESSURE AFTER TREATMENT 66 42. RESPONSE ON DIASTOLIC BLOOD PRESSURE AT FOLLOW UP 66 43. RESPONSE ON WEIGHT AFTER TREATMENT 67 44. RESPONSE ON WEIGHT AT FOLLOW UP 67 45. RESPONSE ON HEMOGLOBIN AFTER TREATMENT 67 46. RESPONSE ON VISUAL ACUITY (RT. EYE) AFTER TREATMENT 68 47. RESPONSE ON VISUAL ACUITY (LT. EYE) AFTER TREATMENT 68
  • 14. -1- INTRODUCTION INTRODUCTION ‘Home’ is not where the heart is, ‘Life’ is work and worry, ‘Love’ is children voice on the telephone, ‘Affection’ is their message on the internet, ‘Caring’ is the nurse they engage when ill, ‘Responsibility’ is the money they pay through the bank account. This is the present definition of old age. When we want to impress foreignersabout the future of our booming economy, we always emphasize that half of ourpopulation is under the age of 24. This is often referred to as the population dividend!However there is a flip side.With improving health care, our average life expectancy has risen from 57 in 1990 to65 today. In the next two decades, India will also be the home to the world’s secondlargest population of the elderly. The age wave means that the no. of senior citizens isexpected to touch 198 million in 2030.Population ageing rising many fundamental questions such as How do we help remain independent and active as they age? How can we strengthen health promotion and prevention policies, especially those directed to older people? As people are living longer how the qualities of life can in old age improved?While the nature of the health and social problems are leading to depending in old agein developing countries, the need to focus on promoting health and minimizingdependency of all older people is a common principle of action. This approach hasbeen termed “Healthy ageing” or “Ageing well”, the world health organization has anunique opportunity and a major responsibility to take a leadership role in this area ofpopulation health. Aging is a natural inevitable, irreversible always progressive biologicalprocess associated with decline of physical and mental functions. Study of aging at A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 15. -2- INTRODUCTIONdifferent levels such as social, behavioral, physiological, morphological, cellular andmolecular is need of the hour. The tremendous advances in biological and medical research have succeededin controlling several diseases, while this research decreased the death rate of youngpeople, it has at the same time, pushed a large number of people to old age. Neitherthe duration of youthful life nor the maximum life span has been prolonged. Only theaverage life span has increased. This is resulted in an ever increasing number of oldpeople in every nation. The problem before the scientist therefore is how to keep theold people physically fit and how to make them useful to society. This calls forintensive research into the causes which lead to aging. Bio gerontologists have an obligation to emphasize that the goal of research onaging is not to increase the human longevity regardless of the consequences, but toincrease active longevity free from disability and functional dependence. Sir Jamessterling Ross commented “you do not head old age, you protect it, you promote it, andyou extend it”. Ayurveda the science of life has always viewed aging as graceful phase of life.It recognizes aging as a naturally occurring disease along with hunger, thirst, sleepand death. Old age and its health problems were great concern even for the Acharyasduring Vedic period, which was the reason why one of the branches of medicinecalled “Jara chikitsa”, was dedicated. It implies prevention of old age and managingproblems of old age by using the rasayana therapy. This therapy has wild emphasizedits role in promoting, protecting and extending the aging process. It is the therapywhich gives the longevity, enhances memory and intellect maintenance good healthand restores youth, complexion, body, color and voice. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 16. -3- INTRODUCTION Keeping above factors in mind Amalaki and Ashwagandha drugs were chosento evaluate their efficacy in Jara Awastha. Both these indigenous drugs are known fortheir peculiar properties. Medical Science has made rapid strides in the past decade. It is difficult, if notimpossible to input all the vast scientific materials available, so attempt has beenmade to compile this information in a manner which would benefit the other scholarswho are already loaded with internet, monographs, journals and other update. It maybe read from cover to cover or approached piecemeal as seems appropriate.Constructive criticisms are as always welcomed. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 17. -4- OBJECTIVES OBJECTIVES OF STUDY 1) To study Jara awastha with respect to ageing process. 2) To evaluate the efficacy of Amalaki and Ashwagandha in elderly persons. 3) To compare the efficacy of both the drugs in elderly persons. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 18. -5- REVIEW OF LITERATURE REVIEWParibhasa – derived from the root ‘jrusha vayohanou’ i.e. growing older (SKD)Definition • “ Vayah kruta shlathamamsadyavastha visesha” 1 Meaning loosening of muscles and other tissues under the influence of aging. • According to “Gurubalaprabodhika” commentary on Amarkosha. 1 “Jeeryant anayo angani iti jara” conveying the meaning of degeneration of bodily organ. • In Shabda Sthoma Mahanidhi. 2 The word ‘jara’ has been defined as “Shaithilya Apadakavastha Bhedi” the Avasthabheda, which brings shaithilya avastha.SYNONYMS OF JARA AND VRUDDHA3Different synonyms have been described in Sanskrit literatures which illustrate thedifferent facts of old age and the aged individual.Synonyms of Jara:Sthaveeram - The aspect of being old.Visrasa - The degradation of the shareera.Synonyms of Vruddha:Vruddha - One who has already attained vruddhiPravayaha - One who has crossed his youth.Sthaveera - One who has stayed for a long time.Jeenaha - One who is attaining deterioration.Jirna - One who is attaining deterioration.Jyaynha - One who is at the stage of 90 years. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 19. -6- REVIEW OF LITERATURE The word ‘Ageing’ has been derived from the Latin term ‘AETAS’4 it meansthe process of growing old, resulting in failure of body cells to function normally or toproduce new body cells to replace those which are dead or malfunctioning. Thus theword ‘jara’ is similar to that of aging and it conveys the meaning like 1. A continuous process of growing older. 2. A particular period of life, where the body tissues attain deterioration or flaccidity.HISTORICAL REVIEW 5 1. “Deerghayu mantra sangrah” is mentioned in Atharvaveda to ensure a healthier and longer life. 2. A Rishipatni known as “Khalegosha” is said to have overcome jara, with the treatment given by Ashwini Kumaras. 3. Chyawanprasha was formulated to enable Chyawana Maharshi to lead a long life free from Jarajanyavikaras. 4. In Sreemadbhagavata and Valmikiramayana there are references, which highlights the state of Jara. 5. Factors accelerating aging and measures to control it are described in Brahmapurana.DIVISIONS OF LIFE SPAN 6 Life span is the maximum number of years that a human can live. That isfundamentally different from life expectancy, which is the average number of yearsthat a human expects to live. Acharya Charaka has mentioned human life span in declination with concernto different yuga. i.e. 400 yrs kruta/satya yuga, 300yrs in tretayuga, 200yrs inDwapara yuga and 100yrs in kaliyuga. Varshashatam khaluayusha pramanam asmin kale (Ch vi 8/122) A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 20. -7- REVIEW OF LITERATUREThe current period of present era kalyuga, the human life span has been considered as100yrs. This may decline in future and this period (100yrs life span) is broadlydivided into 3 division’s i.e.1) Balya – Young. 2) Madhya – Middle 3)Vruddha – Old.Vaya (Age)Definition of Vaya 6: - Age is defined as the state of the body corresponding to length of time, TABLE NO. 1Classification of Vaya according to Ayurvedic AcharyasAcharya Balyam Madhyama VardhikyaCharaka Birth to 30 years 30 – 60 years 60 – 100 years 1. Aparipakvadhatu,- Birth to 16 years 2. VivardhamandhatuSushruta Birth to 16 years 16 – 70 years 70 years onwards 1. Ksheerapa – Birth to 1 year Vriddhi 16-20yrs 2. Ksheerannada –1 – 2 years Yauvana 20-30yrs 3. Annada – 2 – 16 years Sampurna 30-40yrs Hani 40-70yrsVagbhata Birth to 34 years 34 – 70 years 70 years onwards 1. Kumara – Birth to 16 years 2. Yauvana –16 – 34 yearsTypes of Aging: - Old age is an undesirable, inevitable phase of human life, the onset of signsand symptoms of aging is evident at the age of 60, (a stage of old age). The tell tale markers of an aged individuals are graying of hair, loss of hair;vision and hearing impairment, wrinkling of skin and loss of elasticity and dry skinetc. However these are not strictly chronologically age related. In other words, thesechanges might appear in individual who might be 50 or they might not appear in anindividual who is 70, their appearance may varies from the individual to another7.Thedecline of each organ system appears to occur independently of changes in other A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 21. -8- REVIEW OF LITERATUREorgan systems and is influenced by diet, environment and personal habits as well asgenetic factors. 8 Types of Jara (Aging)Kalaja Vaya (Normal aging) Sukhayu (Healthy aging)Akalaja Vaya (Premature aging) Dukhayu (Pathological aging)Kalaja Jara (Normal aging): - Sushruta has categorized the swabhavabala pravrutta vyadhi’s into 2 types i.e.Kalaja (timely occurring) and Akalaja (untimely occurring). 9 (Su.Su. 24/7). Jara isone among them. Dalhana opines that Kalaja means “ye samayepraptabhavanti “i.ethe one which occurs timely. Hence appearance of signs and symptoms of aging at aparticular scheduled age is considered as Kalaja jara i.e. normal aging. Sushruta further opines that this types of aging is inevitable and there are nocausative factors exists as such to prevent its occurrence, hence he called it as“pariraksha krita” that means it occurs even by following preventive health caremeasures” 9Charka also opines that the person who will follow strictly the health care measureslike Dinacharya (Daily regimes), Rutacharya (seasonal regimes) and Hita vastusevana (good nutritional practice) etc, will going to attain the kalamratyu i.e.senescence followed by death at a particular scheduled time in his life span. Such typeof aging is considered as niyatayu (scheduled aging). 10 (Ch. Vi. 3/38) A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 22. -9- REVIEW OF LITERATURE TABLE NO. 2 Declining of shareer bhava at various decades of life. S.R Decade of life Decline mentioned in A.S.11 Sharagadhara.12 1 1st Decade Childhood Childhood 2 2nd decade Growth Growth 3 3rd decade Complexion Complexion 4 4th decade Medha (intellect) Medha (intellect) 5 5th decade Skin Skin 6 6th decade Shukra Drishti 7 7th decade Drishti Shukra 8 8th decade Hearing Vikram 9 9th decade Mind Buddhi 10 10th decade Function of all the Indriyas Karmendriya 11 11th decade - Mind 12 12th decade - Life.AKALAJA JARA (Premature Aging) Dalhana explained that, Akalaja means “asamaye jata” i.e. one which occursuntimely. 13 Hence appearance of signs and symptoms of aging prior to scheduled ageis considered as Akalaj jara (premature aging). Sushruta further opines that this type of aging is acquired one. Hence he calledit as “aparirakshanakrita” that means it occurs by following improper health caremeasures. 13 Charaka opines that the process of aging will be accelerated in individualswho follow the improper health care measures and such individuals are prone to have“akalamrutyu” i.e. senescence followed by death prior to the schedule age. Such typeof aging is considered as Aniyatayu (unscheduled aging). 14 (Ch. Vi 3/38) Chakrapani considered the occurrence of premature aging in persons havingthe features of short life span (Avarayu) .Rasavagbhata15 and Brahmashankara Mishra in Madhava Nidana parishisthamentioned some of the etiological factors and signs and symptoms of premature A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 23. - 10 - REVIEW OF LITERATUREaging. The etiological factors of akalamrutyu (untimely death) may be considered asetiological factors for premature aging. ETIOLOGYFactors responsible for Kalaja Jara: - Now it is evident that jara is of 2 types i.e. natural and premature there areparticular etiology for premature aging but no separate etiology mentioned in theclassics for natural aging why because it is naturally occurring phenomenon.Nidana of Akalaja Jara :Madhava Nidhana 16 explain the cause of jara as, 1. Ati padgamana - Excess Walking 2. Ati Sitasevana - Excessive cold intake 3. Khadanna Bhojana – Improper food consumption 4. Continuous Maithuna Karma with Vraddha Stree – Excessive indulgence in sex with elderly wife. 5. Manasika Dukha etc –Mental StressAbove mentioned are the causes responsible to manifest Jara roga.Rasaratna Samuchaya 17 also supports the same view of Madhavkara. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 24. - 11 - REVIEW OF LITERATUREEtiology of Akalamrityu (Acc. To Ch Vi 3/38) 18 1) Ayathabalamarambha – over strain 2) Ayatha agni abhyavaharan – eating in excess of ones own digestive power 3) Vishama abhyavaharan – irregular meal 4) Vishama shareera nyasad – irregular posture of the body 5) Ati maithun – excessive indulgence in sex 6) Asat samsraya - association with wicked persons 7) Udirnavega vinigraha – Suppression of non suppressible urges 8) Vidarya Vega avidharana - Non suppression of suppressible urges 9) Bhoot visha vayu, Agni upatapa – exposure to evil spirits (germs), poison wind and fire. 10) Abhighata- exposure to injury 11) Ahara and Pratikara vivarjana- avoidance of food and medicine.JARA PURVA ROOPA19 Acharya Madhavakara has mentioned followings purvaroopa of jara asShakti ksheenata – Diminuation of strengthSmriti nash – Diminuation of memoryGlani – lethargyVali –Wrinkling of skinPalitya-Grey hairDantha shaithilya- Flabbiness of body tissuesSvabhava parivarthana etc – Change in mood A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 25. - 12 - REVIEW OF LITERATURE ROOPA TABLE NO. 3FEATURES OF AGEING ACCORDING TO AYURVEDIC CLASSICSNO FEATURES OF AGING Ch20 Su21 AS22 BP23 MN24A Features of Ageing on Body1. Heeyamana dhatu (↓ body tissue) + + + + +2. Bhrushyamana dhatuguna(↓body tissue) + - - - -3. Dhatukshaya(↓body tissue) - - + - -4. Heeyamana veerya/ reta(↓fertility) + + - + +5. Shlatha asara mamsa , sandhi, asthi(flabbiness in the muscular, bony tissue and joints) - - + - -6. Vali (skin wrinkle) - + + + -7. Twak parushya(dry skin) - - + - -8. Palitya(white hairs) - + + + +9. Khalitya(Hair loss) - + - + -10. Heeyamana Indriya(↓sensory organs) + + + + +11. Heeyamana vachana(↓speech/voice) + - + - -12. Avanama kayasya(senile kyphosis) - - + - +13. Manya hani - + - - -14. Vepathu(senile tremors) - - + - +15. Agni sada(↓digestion and metabolism) - - + - +16. Maruto dreka (provocation of vata insomnia,constipation etc.) + - + - +17. Kasa, Swasa(Respiratory changes) - + + + +18. Shleshma singhanodeerana(Respiratory changes) - - + - +B. Features of Ageing on Mind.1. Heeyamana grahana (↓ power of understanding) + - - - -2. Heeyamana dharana(↓retention) + - - - -3. Heeyamana smarana(↓memory) + - - - +4. Heeyamana vijnana(↓analyzing facts) + - - - -5. Ksheeyamana utsaha (↓enthusiasm/ depression) - + - - +6. Heeyamana parakarma (↓manobala +mental + - - - + stamina)C. Other1. Heeyamana bala (↓ strength) + + + - +2. Heeyamana porusha(↓valour) + - - - +3. Sarvakriyaswasamarthata / karma suchaakshama(↓physical disability) - + - + +4. Ojakshaya(↓ immunity) - - - - - A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 26. - 13 - REVIEW OF LITERATUREFactors Accelerating Aging 25A unique concept of geriatrics is hidden in Ayurvedic medicine, explaining the factorsaccelerating the aging process. Charaka, while describing the scope of rasayanachikitsa, which aids in regeneration of Dhatus, has stated that the chief contributingfactor of deterioration of the body is Gramyavasadosha, (Ch. Chi. 1/2/3)AHARA-Amla lavan katuk kshara shushka shaka mamsa tila palala pistanna Bhojinam.Viradha nava shukashami dhanya viruddhha asatmya ruksha kshara abhishyandiBhojinim.Klinna guru puti paryushita bhojinim vishma, Adhyshana.VIHARA- Nitya – Divaswapna, stri, Madya,Vishma atimatra vyayamaMANO AVASTA- Bhaya, Krodha, Soka, Lobha, Moha and Ayasa. All these factors attributed during Charaka days are still prevalent today,aiding faster degeneration tendencies among the population.KARYADue to these factors the effects seen are Mamsasaithilya, Sandhimoksha,Raktavidaha, Medavisyandana, Majja asandhana, Sukra apravartana and Ojokshaya.ROOPAAll these pathological events are represented in the following features appearing as aconsequence of “Gramya Ahara Vihara” 1) Glani – a condition of uneasiness. 2) Sada- body discomfort. 3) Nidra, Tandra Alasya – sleep, laziness, loss of interest. 4) Nirutsaha – lack of drive in daily activities. 5) Swasa – Dyspnoea on slight exertion. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 27. - 14 - REVIEW OF LITERATURE 6) Asamartha cheshtanam of Shareera and manas: Hypo function of body and mind. 7) Nashta smriti Buddhi and Chaya – Depletion of memory, intellectual functions and complexion. 8) Roganam Adhishthana Bhuto – Body is rendered the ‘Seat of multiple disease entities’ 9) Na Sarvam Ayu Avapnoti – that is the person cannot enjoy the full span of life or ‘Shatayu’. MODERN REVIEWDerivation of Geriatrics 26:It is derived from the Greek Root “ger-gero-geronto” meaning old age or the aged.Definition of aging 27: “Aging is characterized by failure to maintain homeostasis under conditions ofphysiological stress and this failure is associated with a decrease in viability and anincrease in vulnerability of the individual”.Different Terminology of Geriatrics 28:Old age: It is defined as the period beyond the retirement age, by some visually takenas starting around 65 years of age.Senescence: The process of growing old, especially the condition resulting from thetransition and accumulation of the deleterious ageing process.Senile: Pertaining to old age.Senilism: Premature old age.Senility: The physical and mental deterioration associated with old age.Ageism: The attitude of discrimination against the elderly in the context of prognosisand medical care has come to be known as ageism. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 28. - 15 - REVIEW OF LITERATUREDivisions of Old age Set old age 60-75 years. Old old age 75-85 years. Ripe old age above 85 years.Historical ReviewThe curiosity on old age and its disease seems to be as old as recorded medicine itself. a) Pythagoras recorded the stages of man as child hood, youth, manhood and old age, the most important of these being Gerocomice or old age. b) Hippocrates (400 BC) wrote. In old people catarrhs accompanied with coughs, dysuria, pain of the joints difficulty in micturation, kidney disease, dizziness, pruritis of the whole body insomnolency, defluxs from the bowels, eyes & nostrils, dimness of sight, cataract and hardness of hearing occur. c) In roman times, units for the care of old people were called Gerocomia. By 1000 AD, the Arabian Avicenna outlines the care of the aged in his canon of medicine. d) In medieval times, “the poor laws” were passed in 1597 and 1607 to keep the poor away from the streets. This system eventually came to provide for the old, chronically sick people for a short while. e) By 1782, the infamous workhouses remained asylums for the old and infirm, even through the French revolution and Florence Nightingale’s time.Physiology of Ageing 29:Ageing refers to all time associated events that occur during the lifespan of anorganism. Here are many changes occur in the physiologic process. These changesalso named senescence, which is defined as the deteriorative changes with the time A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 29. - 16 - REVIEW OF LITERATUREduring post maturation life that underlie an increasing vulnerability to challengesthere by decreasing the ability of organism to survive.Cause of age associated physiological deterioration: Apparently repairs during thepost maturational life are not able to fully eliminate the damage. The result of this is aprogressive function in inadequacy of the physiologic system due to the accumulationof damage.This damage basically caused by three factors.i) Damage resulting from the intrinsic living processii) Damage caused by extrinsic factorsiii) Damage resulting from age associated diseasei) Damage resulting from the intrinsic living processMany of the processes essential to life also have damaging aspects. For exampleaerobic metabolism, which enable organism to readily, generate metabolic energyfrom the ingested nutrients. In addition to this serving as energy source of glucosealso participates in the glyco-oxidation of protein and nucleic acid may alters theirbiologic functions.ii) Damage caused by extrinsic factors:The subjective influence of psychosocial factors on human ageing is in the verypreliminary stages of study and requires much further investigation i.e. the pathwayslinking the psychosocial factors to physiologic systems must be delineated.iii) Damage resulting from age associated diseaseBiologist proposes that ageing occurs because of the decline in the force of naturalselection with advancing age. It is for this reason that physiological deteriorationincreases with increasing age. For example, loss of bone mass is a well recognizedage associated physiologic deterioration and osteoporosis is major age associateddisease. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 30. - 17 - REVIEW OF LITERATURE TABLE NO.4 SELCTED AGE RELATED CHANGES AND THEIR CONSEQUENCES 30S.no ORGAN/ SYSTEM AGE RELATED CONSEQUENCES OF CONSEQUENCE PHYSIOLOGICAL AGE RELATED S OF DISEASE CHANGE PHYSIOLOGICAL CHANGE 1 GENERAL ↑Body fat ↑Volume of Obesity distribution for fat soluble drugs ↓Total body fat ↓Volume of Anorexia distribution for water soluble drugs 2 EYES/EARS Presbyopia ↓Accommodation Lens opacification ↑Susceptibility to Glare Blindness Need for increased illumination ↓High frequency Difficulty Deafness acuity discriminating words if background noise is present 3 ENDOCRINE Impaired glucose ↑Glucose level in Diabetes homeostasis response to acute mellitus illness ↓Thyroxine ↓T4 dose required in Thyroid clearance (and hypothyroidism dysfunction production) ↑ADH. ↓Renin and ↓Na+, ↑K+ ↓aldosterone ↓Testosterone Impotence ↓Vitamin D Osteopenia Osteomalacia, absorption and Fracture activation 4 RESPIRATORY ↓Lung elasticity Ventilation / Perfusion Dyspnea, and mismatch an↓PO2 Hypoxia ↑Chest wall stiffness 5 CARDIOVASCULAR ↓Arterial Hypotensive response Syncope compliance and to ↑HR ,volume ↑systolic depletion , or loss of BP→LVH arterial contraction ↓β-adrenergic ↓Cardiac output and Heart Failure responsiveness HR response to stress ↓Baroreceptor Impaired blood Heart Block sensitivity and ↓SA pressure response to node automaticity standing, volume depletion6 GASTROINTESTINAL ↓Hepatic function Delayed metabolism of Cirrhosis A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 31. - 18 - REVIEW OF LITERATURE some drugs ↓Gastric acidity ↓Ca2+ absorption on Osteoporosis, empty stomach B12 deficiency ↓Colonic motility Constipation Fecal impaction ↓Anorectal function Fecal incontinence7 HEMATOLOGICAL/ ↓Bone marrow Anemia IMMUNE SYSTEM reserve ↓T cell function False negative PPD response ↑Auto antibodies False positive Autoimmune rheumatoid factor, disease antinuclear antibody8 RENAL ↓GFR Impaired excretion of ↑Serum some drugs creatinine ↓Urine Delayed response to ↓↑Na+ concentration/diluti salt or fluid on restriction/overload :nocturia9 GENITOURINARY Vaginal/urethral Dyspareunia, Symptomatic mucosal atrophy Bacteriuria UTI Prostate ↑Residual urine volume Urinary enlargement incontinence; urinary retention10 MUSCULOSKELETAL ↓Lean body mass, Functional muscle impairment ↓Bone density Osteopenia Hip fracture11 NERVOUS SYSTEM Brain atrophy Benign senescent Dementia, forgetfulness delirium ↓Brain catechol Depression synthesis ↓Brain Stiffer Gait Parkinson’s dopaminergic Disease synthesis ↓Righting reflexes ↑Body Sway Falls ↓ Stage 4 sleep Early wakening, Sleep apnea insomnia A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 32. - 19 - REVIEW OF LITERATURE1) Genetic theories 31A. Somatic Mutation theory : - L. Scilard proposed in 1959 that aging is due to random mutations (unusual changes ingenetic material) which destroy genes and cause loss of chromosomes of somatic cells. Due tosuch mutations, these genes do not produce any proteins or if they do so, the proteins aredefective. Mutation after reaching a certain level inactivates the cells and causes their death. Theorganisms die when the number of these cells decreases below a certain levels.B. Gene Regulation theory:- Since specific genes direct the synthesis of specific proteins these differences may bedue to the difference in the activities of genes. Aging may be due to the failure of organism tomaintain the activities of genes, required for the reproductive and adult phase.C. Genomic Instability theory:- Suggest that errors in genetic transportation and translation results in impaired proteinsynthesis and deterioration in all function as age.2) Non Genetic theories These are based on the possibilities that the balance between ongoing damage and repair is disturbed.a) Error theory Proposes that error occurs in amino acid consequences of enzymes like RNApolymerase and aminoacyl t-RNA synthetase which are responsible for protein synthesis. Suchmistakes may amplify the production of wrong proteins which on reaching critical levels makesthe cells function less. b) Free Radical theory Proposes that endogenous oxygen radicals were generated in cells and results in aprotein of cumulative damage. The burden of reactive oxygen species(ROS) production islargely countered by an intricate antioxidant defense system that includes the enzymes A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 33. - 20 - REVIEW OF LITERATURE scanvenger SOD (superoxide dismutase), catalase and glutathione peroxidase and a variety of other non-enzymatic, low molecular mass molecules which are important in scavenging ROS. These include ascorbate pyravate flavonoids, caratenoids and perhaps most important glutathione. The antioxidant defense mechanism decreases as age and resulting in arise of intracellular oxidant levels which have potentially important effects. i. Damage to various cell components. ii. Triggering of the activation of specific signaling pathways.iii. Both of these effects can influence the numerous cellular process linked to aging and to development of age related disease. c) Hormonal changes: - Human growth hormones produced in the pituitary gland plays a critical part in normal childhood growth and development. It levels decreases in about ½ of adult with passage of time. The decline of GH seems to play a role in the aging process at least in some individuals. Changes in other hormones like estrogen and progesterone alter the gene expression. d) Changes in Proteins:- (i) Enzymatic activity: - Some enzymes decrease in activity, some increase and several others do not change with age, some enzymes like acetyl cholinesterone (ACHE) of the brain where as GABA (Gamma Amino Butaric Acid) and glutamate stimulate it, these effects decrease significantly in old rats. Ache maintains the level of acetylcholine (Ach). It is possible that such qualitative changes in the enzymes of the brain may account for the decrease in its functions like learning and memory in old age. (ii) Other proteins: - The rate of protein synthesis is good index of activity of cells. Collagens the extra cellular protein of connective tissue constitutes about 30% of the total proteins of the body. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 34. - 21 - REVIEW OF LITERATUREIt becomes insoluble due to increasing number of cross linkers and prevents the flow ofnutrients to cells.e) Age pigments: - During the aging of animals, accumulation of age pigment occurs which is alsocalled as lipofusion in the cytoplasm of non dividing cells like neurons, cardiac and skeletalmuscles and also in connective tissue cells. The pigment may arise by metabolic disturbances such as interaction of oxidantswith poly unsaturated fatty acids. The cause of accumulation of pigment is not clear, but itis evident that if a large fraction of the cytoplasm is occupied by an inert substance, it willno doubt affect its metabolism and function.f) Cross linkers: - J. Byorksten proposes that aging is due to cross linking of macro molecules, nucleic acidand proteins, which are vital for cell function. These accumulates with age and may not only crosslink two or more enzymes and inactive them but also may act at the level of the genes. Freeradicals, atoms, or molecules having at least 1 unpaired electron can also cross link two molecules.Enzymes and nucleic acids may react with these free radicals and get inactivated.g) Immune response: -There is gradual decrease in the number of antibody producing cells and hence defensemechanism decreases with age.From above explanation it is evident the genetic and non genetic theories ultimately speakabout the derangement in cell structure and functions which results in cellular senescence. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 35. - 22 - REVIEW OF LITERATURE DRUG REVIEW AMALAKI 32, 33Sanskrit name : AmalakiLatin name : Emblica officinalisBotanical name : AmalakiVernacular name : E – Emblica myrobalan K – Nellikayi M – Avala Anvala H – Amvala, AmvaraKula : Eranda kulaFamily: EuphorbiaceaGana: Vayasthapana, Virechanopaga ( Ch.)Habitat: All over India.Botanical Description: Middle size tree, height 20-25 fts.Flower: Small and yellow in colour.Fruit : Round in shape 1.5 cms in diameter with a wrinkled surface of yellowish brownor greenish black in colour. Fruits break easily exposing a section of dried pulp and nut ,which contains triangular seed of yellowish brown in colour. Fresh fruit is globularfleshy obscurely 6 lobed and measured 2-3 cms in diameter surface smooth yellowishgreen coloured and contain juicy pulp.Properties Rasa : Amla pradhana lavan varjta pancharasa Veerya : Sheeta Vipaka : Madhur Guna : Laghu , Rooksha Doshagnata : Tridosha Karma : Vrushya , Rasayana , Chakshushya Rogaghnata : Prameha, Shota, Raktapitta, Shosha, Jwara, Chardi, Amlapitta A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 36. - 23 - REVIEW OF LITERATUREChemical composition: It is rich source of Vit c and contains 500-700mg/100gms of fresh pulp . Apart from that fruits also contain 5% of Farphyllemblin and 5% tannin . Fruits are alsorich in mineral matters like phosphorus , iron and calcium . It contains appreciable amountof Pectin. It has been found that vitamin content of dried fruits is not lost considerablymay be due to the presence of tannins .Part used: Phala majja Dose: Churna 6 masha to one tola ASHWAGANDHA34,35Synonyms:Varahkarni, Balada, Gandhata, Kusthagandhani, Vardha, Turagi, Harya, Vrishya, Vajikari,Durgandha, Hyagandha.Vernacular names:Latin name: Withania Somnifera (Linn). Gujrati: Asgandha.Sanskrit: Hyagandha, Vajigandha. English: Winter cherry.Hindi: Asgandha. Kannada: Angaraberu, Hiremaddina.Punjabi: Asgandh.Family: Solanaceae (Kanthakari kula).Botanical description: The wild plants are generally erect branching shrub up to 2 – 4 feet in height. Thecultivated plants are morphologically distinct from wild plants. They differ in theirtherapeutic properties as well as morphological characters like roots, stem, leaves, flowers,pollen grains and fruits. It is a perennial herb found in waste land, cultivated field and opengrounds throughout India. In Himalayas found up to at the height of 5000 feet’s. Widelycultivated in certain area of M.P. and Rajasthan. In M.P. maximum cultivated at Mansavillage in Mandsoor district. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 37. - 24 - REVIEW OF LITERATURELeaves: Alternate, simple, often in unequal pairs 5 – 10 cm long, 2.5 – 5 cm broad.Flowers: Complete, bisexual, regular, persistent yellowish green, comes inflorescence.Fruit: Small, round, red in colour after ripening, they are berry or capsule.Seeds: Many, yellowish with pitted testa, kidney shaped.Roots: 1 – 1 ½ feet long, 1 – 1 ½ inch thick hard and light brown in colour from outside andwhite from inside. It smells is like horse urine. The entire plants are uprooted for the collectionof roots. Root cultivated in winter and is separated from the underground parts as soon aspossible, after collection by cutting the stems 1 – 2 cm above the crowns.Properties:Rasa : Madhur, Tikta, Kashaya. Virya : Ushna.Vipaka : Madhur. Guna : Laghu, Snigdha.Karma : Vata Shamaka, Kaphagna.Gana : Balya, Brahniya, Madhurskanda (Ch), Shukral, Rasayana vajikarna (B.P.), Vatahara(SH), Vatavikarjit, Rasayan (V).Chemical composition: Bitter alkaloids: Somniferin: Hyphotic properties. Phytosterol, Resin, Fat mixtures ofsaturated and unsaturated acids. Several steroidal lactones: Withanolides. Other alkaloids: Cusohygraine,Trophine,Anaferine,Withasomaniferine,Vasamine. Withanolides are responsible for its analgesic and anti inflammatory effect. It has remarkableanabolic activity.Useful parts: Roots. Dose: 3 – 6 gm in powder form.Formulations: Ashwagandha choorna, Ashwagandha ghrita, Ashwagandha kwatha,Ashwagandhi awaleh, Ashwagandharist. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 38. - 25 - MATERIALS AND METHODS MATERIALS AND METHODSMATERIALS OF THE STUDY:A) Drugs : 1) Group A - Amalaki Churna 2) Group B - Ashwagandha churnaSource of drugs : Amalaki and Ashwagandha Churna are prepared as per the classicalreference at Pavaman Pharmaceuticals pvt. Ltd. Bijapur – 586101B) Thirty old age personsC) Instruments 1) Sphygmomanometer 2) Clinical Torch 3) Clinical Thermometer 4) Stop Watch 5) Snell’s chartMETHODS: OBJECTIVES OF STUDY: 1) To study Jara awastha with respect to ageing process. 2) To evaluate the efficacy of Amalaki and Ashwagandha in elderly persons. 3) To compare the efficacy of both the drugs in ageing process .Sources : The literary sources of present study are collected from the classical texts of Ayurveda, published journals, modern texts, international editions and internet. The elderly persons were taken from OPD and IPD of DR. B.N.M.E. Trust’s Shri Mallikarjun Swamiji PG and RC, Bijapur and Medical camps conducted by the institute. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 39. - 26 - MATERIALS AND METHODSSampling method:Minimum of 30 elderly persons were selected excluding drop outs. They wereassigned into two groups consisting of 15 persons in each group viz:Group A andGroup B. Statistical analysis was done on subjective parameters such as IndriyaKshaya, Bala Kshaya, Grahana Kshaya, etc. and objective parameters such asHaemoglobin, Blood Pressure Etc. as mentioned in Ayurvedic and modern texts by‘Student’s t-test’.INCLUSIVE CRITERIA: 1) Elderly persons with classical symptoms of Jara such as Indriya Kshaya, Bala Kshaya Etc. 2) Both sex. 3) Age group in between 60 to 70yrs.EXCLUSIVE CRITERIA: 1) Elderly persons suffering from any other systemic disorders. 2) Age above 70yrs. 3) Senile psychosis. 4) Elderly persons who are non co-operative.Study Design GROUP A: DRUG : AMALAKI CHURNA DOSE : 5 gm B.D. METHOD : ORAL ADMINISTRATION ANUPANA : SUKHOSHAN JALA DURATION : 60 DAYS FOLLOW UP : 30TH DAY GROUP B: DRUG : ASHWAGANDHA CHURNA DOSE : 5 gm B.D. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 40. - 27 - MATERIALS AND METHODS METHOD : ORAL ADMINISTRATION ANUPANA : SUKHOSHAN JALA DURATION : 60 DAYS FOLLOW UP : 30TH DAYInvestigations will be done for both the groups before and after the treatment.Investigations: 1) Hemoglobin. 2) Blood pressure 3) Visual Acuity.ASSESMENT CRITERIA AND THEIR GRADINGSSUBJECTIVE PARAMETERS1) AGNI MANDYA (Loss of Appetite): Grade 1: Normal Appetite. Grade 2: Diminished Appetite. Grade 3: Loss of interest in taking food. Grade 4: Aversion towards food.2) MALA BADDHATA (Constipation): Grade 1: No Constipation. Grade 2: Regular bowel movements, consistency hard, excessive straining, and prolonged defecation time. Grade 3: 3-5 Bowel movements per week, consistency hard. Grade 4: Less than 3 Bowel movements per week, consistency hard.3) INDRIYA KSHAYA (Peripheral neuropathy): Grade 1: Normal reflexes. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 41. - 28 - MATERIALS AND METHODS Grade 2 : Occasionally tingling ,prickling ,burning or band like dysesthesias in the balls of the feet or tips of the toes, or in general distribution over the toes. Grade 3: Dysesthesias spread up to lower legs, weakness in the feet. Grade 4: Wooden feeling in the feet, loss of reflexes. Difficulty in walking on heels.4) BALA KSHAYA (Strength): Grade 1 : Normal strength. Grade 2 : Movement against some resistance only. Grade 3 : Movement against gravity only. Grade 4 : Movement with gravity eliminated only. Grade 5 : Palpable contraction or flicker. Grade 6 : No movement..5) GRAHANA KSHAYA(Grasping power): Person is asked to withhold the cuff of sphygmomanometer in folding manner for maximum time at maximum mercury level. Grade 1 : Can withhold more than 2min. Grade 2 : Can withhold in between 61 sec.– 2 min. Grade 3 : Can withhold in between 30-60 sec. Grade 4 : Can withhold less than 30 sec.6) NIDRA NASHA (Insomnia ): Grade 1 : Adequate night sleep 6-8 hours. Grade 2 : Inadequate night sleep 4-5 hours Grade 3 : Inadequate night sleep 2-3 hours. Grade 4 : Inadequate night sleep 1-2 hours or no sleep. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 42. - 29 - MATERIALS AND METHODS7) SHWASA (Exertional Dyspnoea) : Grade 1 : Dyspnoea on unaccustomed exertion. Grade 2 : Dyspnoea on accustomed exertional work. Grade 3 : Dyspnoea on routine activities like moving about in the house, going to toilet, having bath . Grade 4 : Dyspnoea on rest.8) SARVAKRIYA ASWASAMARTH (Functional impairment): Grade 1 : Can perform routine work. No pain in joints of extremities. Grade 2 : Mild pain and stiffness in joints, walks with limping but without support. Grade 3 : Painful joints, walk without support, difficulty in performing daily routine. Grade 4 : Painful joints, Totally unable to perform daily routine.OBJECTIVE PARAMETERS Systolic Blood Pressure Grade I 100-130 mm of Hg. Grade IV 152-160 mm of Hg Grade II 132-140 mm of Hg Grade V above 160 Grade III 142 -150 mm of Hg Diastolic Blood Pressure Grade I 70-90 mm of Hg. Grade II 92-100 mm of Hg. Grade III 102-110 mm of Hg. Grade IV above 112 mm of Hg. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 43. - 30 - MATERIALS AND METHODS Weight Grade I 70kg and above Grade V 50-55 kg Grade II 65-70kg. Grade VI 45-50 kg. Grade III 60-65kg. Grade VII 40-45 kg. Grade IV 55-60 kg Grade VIII below 40 kg. Haemoglobin Grade I 14gm% and above Grade IV 08-10 gm.% Grade II 12- 14 gm % Grade V less than 08 gm % Grade III 10-12 gm% Visual Acuity Grade I 6/6 Grade VI 6/36 Grade II 6/9 Grade VII 6/60 Grade III 6/12 Grade VIII FC5` Grade IV 6/18 Grade IX FC 4`and below Grade V 6/24Assessment on clinical improvement: Clinical improvement of the disease was based on improvement in the clinical finding and reduction on the severity of the symptoms of the disease grading for the clinical improvement for individual variables. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 44. - 31 - MATERIALS AND METHODSGrading for the clinical improvement for individual variables. 1. CD : Clinically deteriorated i.e. increase in severity score against the initial score. 2. CS : Clinically stable, i.e. severity score remains as against the initial score. 3. CI-I: encouraging i.e. I degree reduction in the severity score, against Initial score, i.e. reduction from mild-normal, Moderate-Mild and Severe- moderate. 4. CI-II: Good i.e. 2 degree reduction in the severity score, against the score, i.e. reduction from moderate-normal, severe-mild. 5. CI-II: excellent i.e. 3 degree reduction in the severity score, against the Initial Score, i.e. severe- normal. Grading for clinical improvement of overall severity: 1. CD : Clinically deteriorated i.e. increase in severity score against the initial Score. 2. CS : Clinically stable, i.e. severity score remains as against the initial score. 3. CI-I : Clinically encouraging (1 – 6 degree reduction in severity score). 4. CI-II: Clinically good i.e. (7 – 12 degree reduction in severity score). 5. CI-III: Clinically excellent i.e. (13 – 18 degree reduction in severity score).Statistical analysis: The data was collected from both groups before, after treatment and at the end of the follow up and statically analyzed by using students‘t’ test with the consultation of biostastician. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 45. - 32 - OBSERVATIONS AND RESULTS OBSERVATIONS AND RESULTS Total 30 persons were taken for the clinical study and they were randomlyallocated to Group A, Group B respectively. The observations for the present studywere done in three stages 1. Generalized observations. 2. Observations for individual group. 3. Results related observations for individual group. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 46. - 33 - OBSERVATIONS AND RESULTS GENERALIZED OBSERVATIONSDistribution according to agen=30 Graph 1 61yrs-65yrs 66yrs-70yrs 20 No. of persons 15 10 5 0 Persons 61yrs-65yrs 18 66yrs-70yrs 12 Age Group Table no – 5 Distribution according to age S.No. Age(yrs) Group A Group B Total(n=30) Percentage 1 61-65 11(73.3%) 07(46.6%) 18 60% 2 66-70 04(26.6%) 08(53.3%)) 12 40% In the present study there was limitation of age. The persons of age between61 to 70 yrs were selected. The Persons of age between 61-65 yrs were 18(60%). No.of Persons between 66-70 yrs observed were 12(40%). A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 47. - 34 - OBSERVATIONS AND RESULTSDistribution according to Sexn=30 Graph 2 Male 20 Female No. of persons 15 10 5 0 Persons Male 20 Female 10 Sex Group Table no – 6 Distribution according to Sex S.No. Sex GroupA Group B Total(n=30) Percentage 1 Male 10(66.6%) 10(66.6%) 20 66.6% 2 Female 05(33.3%) 05(33.3%) 10 33.4% Majority of male persons were observed during the study. i.e. 20 (66.6%) andfemale persons were 10(33.4%). A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 48. - 35 - OBSERVATIONS AND RESULTSDistribution according to Religion Graph 3 HINDU No. of persons 25 20 MUSLIM 15 10 5 0 Persons HINDU 24 MUSLIM 6 Religion group Table no - 7 Distribution according to Religion S.No. Religion GroupA Group B Total Percentage (n=30) 1 Hindu 11(73.3%) 13(86.6%) 24 80% 2 Muslim 04(26.6%) 02(13.3%) 06 20% Majority of persons observed were Hindu 24 persons (80%) and Muslim were06 persons (20%). A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 49. - 36 - OBSERVATIONS AND RESULTSDistribution according occupation Graph 4 12 10 No. of persons 8 6 4 2 0 Persons Agriculture 11 Housewife 9 Business 3 Retired Life 7 OCCUPATION Table no – 8 Distribution according occupation S.No. Occupation GroupA Group B Total(n=30) Percentage 1 Agriculture 08(53.3%) 03(20%) 11 36.6% 2 Housewife 04(26.6%) 05(33.3%) 09 30% 3 Business 01(6.6%) 02(13.3%) 03 10% 4 Retired life 02(13.3%) 05(33.3%) 07 23.4% The persons from various occupations were observed for the study. Amongthem majority were Agriculture 11 persons (36.6%), Housewife 09 persons (30%),Business 03 (10%), persons with retired life 07(23.4%). A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 50. - 37 - OBSERVATIONS AND RESULTSDistribution according to socioeconomic status Graph 5 Poor 20 Middle No. of persons 15 10 High 5 0 Persons High 0 Middle 12 Poor 18 STATUS Table no – 9 Distribution according to socioeconomic statusS.No. Socio GroupA Group B Total(n=30) Percentage economic status 1 High 00 00 00 00% 2 Middle 05(33.3%) 07(46.6%) 12 40% 3 Poor 10(66.6%) 08(53.3%) 18 60% In the present study maximum persons observed were of Poor class i.e. 18persons (60%) while, middle class persons were 12 (40%) each. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 51. - 38 - OBSERVATIONS AND RESULTSDistribution according to food habit Graph 6 Veg. 20 Mix. No. of persons 15 10 5 0 Persons Veg. 20 Mix. 10 Food Habit Table no - 10 Distribution according to food habitS.No. Food habit Group A Group B Total(n=30) Percentage 1 Pure Veg. 10(66.6%) 10(66.6%) 20 66.7% 2 Mix. 05(33.3%) 05(33.3%) 10 33.3% Among the persons observed for study vegetarians were 20 persons (66.7%)and those who took mixed diet were 10 persons (33.3%). A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 52. - 39 - OBSERVATIONS AND RESULTSDistribution according to habits n= 30 Graph 7 TEA /COFEE 18 16 14 GUTKA CHEWING No. of persons 12 ALCOHOL 10 T OB A C C O C HEW IN G SMOKING SM OKING BOTH 1 &2 8 ALCOHOL BOTH 1 &2 TOBACCO CHEWING 6 GUTKA CHEWING 4 TEA /COFEE 2 0 Total HABITS Table no – 11 Distribution according to habits SNO HABITS A B Total % 1 ALCOHOL 3(20%) 2(13.3%) 05 16.7 2 SMOKING 4(26.6%) 2(13.3%) 06 20 3 BOTH 1 &2 2(13.3%) 2(13.3%) 04 13.3 4 TOBACCO CHEWING 5(33.3%) 2(13.3%) 07 23.3 5 GUTKA CHEWING 6(40%) 4(26.6%) 10 33.3 6 TEA /COFEE 10(66.6%) 8(53.3%) 18 60In the present study it was found that 18 persons used to consume excessively Tea andcoffee, 10 and 07 persons were having the habit of Gutka and Tobacco Chewingrespectively. 05 persons had habit of consuming alcohol and 06 persons had habit ofsmoking, where as 04 of persons had the habit of both consuming alcohol andsmoking A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 53. - 40 - OBSERVATIONS AND RESULTSDistribution according to prkruti pradhanata Graph 8 Vata 15 Pitta Kapha No. of persons 10 5 0 Persons Vata 14 Pitta 8 Kapha 8 Prakruti Pradhanata Table no - 12 Distribution according to prkruti pradhanata S.No. Prakruti Group A Group B Total Percentage Pradhanata (n=30) 1 Vata 06(40%) 08(53.3%) 14 46.6% 2 Pitta 04(26.6%) 04(26.6%) 08 26.7% 3 Kapha 05(33.3%) 03(20%) 08 26.7%Majority of the observed persons were of Vata pradhana Prakruti 14 persons (46.6%),with Pitta and Kapha 08 persons each i.e.(26.7%) each. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 54. - 41 - OBSERVATIONS AND RESULTSDistribution According to degree of Systolic blood pressure Graph 9 122-140 20 142-160 No. of persons 15 10 100-120 5 0 Persons 100-120 2 122-140 16 142-160 12 Blood Pressure Table no – 13 Distribution According to degree of Systolic blood pressure S.No. Systolic B.P. Group A Group B Total Percentage (n=30) 1 100-120 00 02(13.3%) 02 6.6% 2 122-140 07(46.6%) 09(60%) 16 53.4% 3 142-160 08(53.3%) 04(26.6%) 12 40% It was observed that the systolic B.P. of majority of old persons was between122-140 mm. of Hg. i.e. 16 persons(53.4%) and least in the group of 100-120mm ofHg. i.e. 02 (6.6%) and in the group of 142-160 mm. of Hg. there were 12 persons(40%). A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 55. - 42 - OBSERVATIONS AND RESULTSDistribution According to degree of Diastolic blood pressure Graph 10 91-100 16 14 101-110 No. of persons 12 10 8 81-90 6 4 <80 2 0 Persons <80 0 81-90 4 91-100 16 101-110 10 Blood Pressure Table no – 14 Distribution According to degree of Diastolic blood pressureS.No. Diastolic B.P. Group A Group B Total Percentage (n=30) 1 <80 0 0 0 00% 2 81-90 01(6.6%) 03(20%) 4 13.3% 3 91-100 07(46.6%) 09(60%) 16 53.3% 4 101-110 07(46.6%) 03(20%) 10 33.4%It was observed that the Diastolic B.P. of majority of old persons was between 91-100mm. of Hg. i.e.16 persons(53.3%) and least in the group of 82-90mm of Hg. i.e. 04(13.3%) and in the group of 101-110 mm. of Hg. There were 10 persons (33.4%). A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 56. - 43 - OBSERVATIONS AND RESULTSDistribution according weight Graph 11 40-50kg 20 50-60kg No. of persons 15 10 <40Kg 5 0 Persons <40Kg 2 40-50k g 16 50-60k g 12 Weight Table no – 15 Distribution according weight.No. Weight(Kg.) Group A Group B Total Percentage (n=30)1 <40 00 02(13.3%) 02 6.6%2 40-50 07(46.6%) 09(60%) 16 53.4%3 50-60 08(53.3%) 04(26.6%) 12 40% It was observed that the Weight of majority of old persons was between 40-50kg. i.e.16 persons(53.3%) and moderate in the group of 50-60kg i.e. 12(40%) andleast in the group of less than 40kg. i.e. 02(6.6%). A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 57. - 44 - OBSERVATIONS AND RESULTSDistribution according to Hb% Graph 12 10-12Hb% No. of persons 20 15 12-14Hb% 10 08-10Hb% 5 0 Persons 08-10Hb % 4 10-12Hb % 18 12-14Hb % 8 Heamoglobin % Table no - 16 Distribution according to Hb%S.No. Heamoglobin Group A Group B Total Percentage (n=30)1 08-10 gm% 03(20%) 01(6.6%) 04 13.3%2 10-12 gm% 09(60%) 09(60%) 18 60%3 12-14 gm% 03(20%) 05(33.3%) 08 26.7%Among the 30 persons majority of the persons 18(60%) were having Hb% between10- 12gm%. Between 12-14gm% there were 08(26.7%) persons and between 08-10gm% there were least no. of persons i.e. 04(13.3%). A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 58. - 45 - OBSERVATIONS AND RESULTSDistribution according to visual accuityRight eye Graph 13 618-636 12 10 No. of persons 8 6 FC6-FC4 4 2 66-612 0 Persons 66-612 0 618-636 16 FC6-FC4 3 <FC4 0 IOL 11 Visual Acuity Table no – 17 Distribution according to visual acuityS.No. Visual Acuity GroupA Group B Total(n=30) Percentage1 66-612 00(00%) 00(00%) 00 00%2 618-636 08(53.3%) 08(53.3%) 16 53.4%3 FC6-FC4 01(6.6%) 02(13.3%) 03 10%4 <FC4 00(00%) 00(00%) 00 00%5 IOL 06(40%) 05(33.3%) 11 37.6% In the present study out of 30 persons maximum persons were having thevisual acuity in the group 618-636 i.e. 16(53.4%) , 3(10%) in the group of FC6-FC4. 11 persons(37.6%) were found to be undergone IOL surgery. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 59. - 46 - OBSERVATIONS AND RESULTSLeft eye Graph 14 618-636 20 15 No. of persons 10 FC6-FC4 5 66-612 0 Persons 66-612 0 618-636 18 FC6-FC4 4 <FC4 1 IOL 7 Visual Acuity Table no – 18 Distribution according to visual acuityS.No. Visual Acuity GroupA Group B Total(n=30) Percentage 1 66-612 00 00 00 00% 2 618-636 10(66.6%) 08(53.3%) 18 60% 3 FC6-FC4 00(00%) 04(26.6%) 04 13.4% 4 <FC4 00(00%) 01(6.6%) 01 3.3% 5 IOL 05(33.3%) 02(13.3%) 07 23.3% In the present study out of 30 persons maximum persons were having thevisual acuity for left eye in the group 618-636 i.e. 18(60 %) , 4(13.4%) in the groupof FC6-FC4. 1(3.3%) were in group <FC4. 07 persons (23.3%) were found to beundergone IOL surgery. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 60. - 47 - OBSERVATIONS AND RESULTS DISTRIBUTION OF PATIENTS BASED ON AGNI MANDYA BEFORE TREATMENT TABLE NO-19 AGNI MANDYA NO. OF TOTAL(n=30) % A SO B S GRADE 4 0 0 0 0 GRADE 3 02 1 3 10 GRADE 2 11 14 25 83.25 GRADE 1 02 0 02 6.66 Graph 15 15 14 No of persons 11 10 Group-A 5 Group-B 2 1 2 0 0 0 0 Gr-4 Gr-3 Gr-2 Gr-1 SeverityDISTRIBUTION OF PATIENTS BASED ON MALABADDHATA BEFORE TREATMENT Table no - 20 NO. OF TOTAL(n=30) % MALABADDHATA PERSONS A B GRADE 4 0 0 0 00 GRADE 3 0 3 3 10 GRADE 2 13 10 23 76.6 GRADE 1 2 2 4 13.33 Graph 16 15 13 No of persons 10 10 Group-A 5 Group-B 3 22 0 00 0 Gr-4 Gr-3 Gr-2 Gr-1 Severity A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 61. - 48 - OBSERVATIONS AND RESULTSDISTRIBUTION OF PATIENTS BASED ON INDRIYA KSHAYA BEFORE TREATMENT Table no - 21 INDRIYA NO. OF TOTAL % KSHAYA A SO B S (n=30) GRADE 4 0 0 0 0 GRADE 3 3 3 6 20 GRADE 2 10 11 21 70 GRADE 1 2 1 3 10 Graph 17 12 11 10 No of persons 10 8 6 4 Group-A 3 3 2 2 1 Group-B 0 0 0 Gr-4 Gr-3 Gr-2 Gr-1 SeverityDISTRIBUTION OF PATIENTS BASED ON NIDRANASHA BEFORE TREATMENT Table no - 22 NIDRANASHA NO. OF TOTAL % A SO B S (n=30) GRADE 4 0 0 0 00 GRADE 3 4 3 7 23.3 GRADE 2 10 10 20 66.6 GRADE 1 1 02 3 10 Graph 18 10 1010 No of persons 8 6 4 4 3 2 2 1 0 0 0 Gr-4 Gr-3 Gr-2 Gr-1 Severity Group-A Group-B A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 62. - 49 - OBSERVATIONS AND RESULTSDISTRIBUTION OF PATIENTS BASED ON BALAKSHAYA BEFORE TREATMENT Table no - 23 BALA NO. OF TOTAL % KSHAYA A SO B S (n=30) GRADE 4 0 0 0 0 GRADE 3 0 0 0 0 GRADE 2 15 15 30 100 GRADE 1 0 0 0 0 Graph 19 15 15 15 No of persons 10 Group-A 5 Group-B 0 0 00 0 0 0 Gr-4 Gr-3 Gr-2 Gr-1 SeverityDISTRIBUTION OF PATIENTS BASED ON GRAHANA KSHAYA BEFORE TREATMENT Table no - 24 GRAHANA NO. OF TOTAL % KSHAYA A SO BS (n=30) GRADE 4 0 0 0 00 GRADE 3 2 6 8 26.6 GRADE 2 13 9 22 73.3 GRADE 1 0 0 0 00 Graph 20 15 13 No of persons 10 9 6 Group-A Group-B 5 2 0 0 0 0 0 Gr-4 Gr-3 Gr-2 Gr-1 Severity A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 63. - 50 - OBSERVATIONS AND RESULTS DISTRIBUTION OF PATIENTS BASED ON SHWASA BEFORE TREATMENT Table no - 25 SHRAMYAMANA NO. OF TOTAL % A SO B S (n=30) GRADE 4 0 0 0 00 GRADE 3 5 6 11 36.6 GRADE 2 10 9 19 63.3 GRADE 1 0 0 0 00 Graph 21 10 10 9 No of persons 8 6 56 Group-A 4 Group-B 2 0 0 0 0 0 Gr-4 Gr-3 Gr-2 Gr-1 Severity DISTRIBUTION OF PATIENTS BASED ON SARVAKRIYA ASWASAMARTH BEFORE TREATMENT Table no - 26 SARVAKRIYA NO. OF TOTAL % ASWASAMARTH A SO B S (n=30) GRADE 4 0 0 0 00 GRADE 3 1 3 4 13.3 GRADE 2 14 12 26 86.6 GRADE 1 0 0 0 00 Graph 22 14 15 12 No of persons 10 Group-A 5 Group-B 3 0 0 1 0 0 0 Gr-4 Gr-3 Gr-2 Gr-1 Severity A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 64. - 51 - OBSERVATIONS AND RESULTS OBSERVATIONS FOR INDIVIDUAL GROUPGroup-A1. All the persons were presenting with varied degree of laxanas.2. Persons were given Amalaki churna 10gm in two divided doses along with sukhoshana jala as anupana for 60 days.3. Persons were comfortable during and at the end of treatment4. No adverse effects were seen.5. All the persons came regularly for the post treatment follow up after 30 days.Group-B1. All the persons were presenting with varied degree of laxanas2. Persons were given Ashwagandha churna 10gm in divided doses twice a day with sukhoshana jala for 60 days.3. Persons were comfortable during and at the end of treatment4. No adverse effects were seen.5. All the persons came regularly for the post treatment follow up after 30 days. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 65. - 52 - OBSERVATIONS AND RESULTS Table no- 28(a) THE RESPONSE OF THE TREATMENT FOR INDIVIDUAL GROUP (%) AFTER TREATMENT Subjective Parameters VARIABLE GROUP CI-3 CI-2 CI-1 CS CD Agni mandya A 0% 0% 73.3% 26.6% 0% B 0% 0% 53.3% 46.6 % 0% A 0% 0% 66.6% 33.3% 0% Mala Baddhata B 0% 0% 46.6% 53.3 % 0% Indriyakshaya A 0% 0% 33.3 % 66.6% 0% B 0% 20 % 60 % 20% 0% A 0% 0% 53.3% 46.6% 0% Nidra Nasha B 0% 6.6 % 73.3% 20 % 0% Bala Kshaya A 0% 0% 20% 80 % 0% B 0% 0% 73.3% 26.6 % 0% A 0% 0% 20% 80% 0%Grahana Kshaya B 0% 26.6% 66.6% 6.6% 0% Shwasa A 0% 0% 33.3 % 66.6% 0% B 0% 0% 73.3 % 26.6 % 0% Sarvakriya A 0% 0% 20% 80% 0% aswasamarth B 0% 0% 80% 20% 0% Table no- 28(b)Objective Parameters VARIABLE GROUP CI-3 CI-2 CI-1 CS CD A 0% 0% 40% 60% 0% Systolic B.P. B 0% 20% 40% 40 % 0% A 0% 0% 26.6% 73.3% 0% DiastolicB.P B 0% 13.33 % 46.6% 40 % 0% A 0% 0% 6.66 % 93.33% 0% Weight B 0% 0% 20 % 80% 0% A 0% 0% 6.6% 86.6% 6.66 % Hb% B 0% 0% 46.6% 53.3 % 0% Visual Acuity A 0% 0% 33.3% 66.6 % 0% (Rt) B 0% 0% 13.3% 86.6 % 0% A 0% 0% 26.6% 73.3% 0%Visual Acuity(lt) B 0% 0% 13.3% 80% 6.6 % A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 66. - 53 - OBSERVATIONS AND RESULTS RESULTS RELATED FOR INDIVIDUAL GROUP AFTER TREATMENT GROUP-A • Excellent response- No patient showed excellent response after treatment. • Good Response- No patient showed Good response after treatment. • Encouraging Response- 73.3% of agnimandhya,66.6% of mala baddhata, 33.3 % of indriya kshaya ,53.3% of nidra nasha ,20% of bala kshaya , 20% of grahana kshaya,33.3% of shwasa, 20% of sarva karya aswasamarth , 40% of systolic blood pressure,26.6% of diastolic blood pressure,6.6% of weight,6.6% of Hb%, 33.3 % of visual acuity in rt eye and 26.6% of visual acuity in lt. eye. Showed encouraging response after treatment. • Stable – 26.6% of agnimandhya, 33.3%of mala baddhata, 66.6% of indriya kshaya , 46.6% of nidra nasha ,80% of bala kshaya, 80% of grahana kshaya, 66.6% of shwasa, 80% of sarva karya aswasamarth , 60% 0f systolic blood pressure,73.3% of diastolic blood pressure,93.3% of weight,86.6% of Hb%, 66.6% of visual acuity in rt eye and 73.3% of visual acuity in lt. eye. were stable after treatment. • Deteriorated – 6.66% persons of Hb% shown clinically deterioration at the end of the treatment. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 67. - 54 - OBSERVATIONS AND RESULTS RESULTS RELATED FOR INDIVIDUAL GROUP AFTER TREATMENT GROUP-B • Excellent response- – No patient showed excellent response after treatment. • Good Response- 20% of indriya kshya, 6.6% of nidra nasha, 26.6 % of grahana kshya, 20% of systolic b.p.,13.3 % of diastolic b.p. showed Good response after treatment. • Encouraging Response- 53.3% of agnimandhya,46.6% of mala baddhata, 60 % of indriya kshaya ,73.3% of nidra nasha , 73.3% of bala kshaya , 66.6% of grahana kshaya,73.3 % of shwasa, 80% of sarva karya aswasamarth , 40% 0f systolic blood pressure,46.6% of diastolic blood pressure,20% of weight,46.6% of Hb%, 13.3 % of visual acuity in rt. eye and 13.3 % of visual acuity in lt. eye. showed encouraging response after treatment. • Stable – 46.6 % of agnimandhya, 53.3% of mala baddhata, 20 % of indriya kshaya ,20% of nidra nasha ,26.6% of bala kshaya , 6.6 % of grahana kshaya,26.6% of shwasa, 20% of sarva karya aswasamarth , 40% 0f systolic blood pressure,40 % of diastolic blood pressure,80% of weight,53.3% of Hb%, 86.6 % of visual acuity in rt eye and 80% of visual acuity in lt. eye. were stable after treatment. • Deteriorated – 6.6% of persons of visual acuity in lt. eye shown clinically deterioration at the end of the treatment. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 68. - 55 - OBSERVATIONS AND RESULTS Table no- 29(a) RESPONSE OF TREATMENT FOR INDIVIDUAL GROUP (%) AT POST TREATMENT FOLLOW UP Subjective Parameters VARIABLE GROUP CI-3 CI-2 CI-1 CS CDAgni mandya A 0% 0% 60% 33.3% 6.66 % B 0% 0% 40% 60% 0% A 0% 0% 46.6% 53.3% 0%Mala Baddhata B 0% 0% 26.6% 66.6% 6.6%Indriya kshaya A 0% 0% 20% 80% 0% B 0% 13.3% 53.3% 33.3% 0% A 0% 0% 20% 80% 0%Nidra Nasha B 0% 0% 53.3% 46.6% 0%Bala Kshaya A 0% 0% 13.3% 86.6% 0% B 0% 0% 46.6% 53.3% 0% A 0% 0% 13.3% 86.6% 0%Grahana Kshaya B 0% 6.6% 80% 13.3% 0%Shwasa A 0% 0% 20% 80% 0% B 0% 0% 53.3% 46.6% 0%Sarvakriya A 0% 0% 13.3% 86.6% 0%aswasamarth B 0% 0% 53.3% 46.6% 0% Table no- 29(b) Objective Parameters VARIABLE GROUP CI-3 CI-2 CI-1 CS CD A 0% 0% 33.3% 53.3% 13.3 % Systolic B.P. B 0% 20% 40% 33.3% 6.6% A 0% 0% 26.6% 66.6% 6.6% Diastolic B.P. B 0% 0% 53.3% 40% 6.6% A 0% 0% 0% 93.3% 6.6% Weight B 0% 0% 20% 80% 0% A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 69. - 56 - OBSERVATIONS AND RESULTS RESULTS RELATED FOR INDIVIDUAL GROUP AT FOLLOW UP GROUP-A AFTER FOLLOW UP • Excellent response- No persons had showed excellent response after treatment. • Good Response- No persons had showed Good response after treatment. • Encouraging Response- 60% of agnimandhya, 46.6% of malabaddhta, 20 % of indriya kshya, 20% of nidra nasha, 13.3% of bala kshaya, 13.3%of grahana kshaya, 20% of shwasa, 13.3% of savakriya aswasamarth, 33.3 % of systolic blood pressure, 26.6 % of diastolic blood pressure persons showed encouraging results. • Stable – 33.3% of agnimandhya,53.3% of malabaddhta,80 % of indriya kshya,80% of nidra nasha ,86.6 % of bala kshaya, 86.6 %of grahana kshaya,80% of shwasa, 86.6% of savakriya aswasamarth,53.3% of systolic blood pressure, 66.6 % of diastolic blood pressure and 93.3 % of weight persons showed stable results. • Deteriorated – 6.6% of agni mandya, 13.3% of systolic B.P., 6.6% of diastolic B.P., 6.6% of weight, persons showed clinically deterioration at the end of the treatment. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 70. - 57 - OBSERVATIONS AND RESULTS RESULTS RELATED FOR INDIVIDUAL GROUP AFTER FOLLOW UP GROUP-B • Excellent response- – No persons had showed excellent response after treatment. • Good Response- 13.3 % of indriya kshaya, 6.6% of grahana kshaya, 20% of systolic b.p. showed Good response after treatment. • Encouraging Response- 40% of agnimandhya,26.6% of malabaddhta,53.3 % of indriya kshya,53.3% of nidra nasha ,46.6% of bala kshaya, 80% of grahana kshaya,53.3% of shwasa, 53.3% of savakriya aswasamarth, 40 % of systolic blood pressure, 53.3 % of diastolic blood pressure 20% of weight persons showed encouraging results. • Stable-60% of agnimandhya,66.6% of malabaddhta,33.3% of indriya kshya, 46.6% of nidra nasha ,53.3% of bala kshaya, 13.3%of grahana kshaya,46.6% of shwasa, 46.6% of savakriya aswasamarth,33.3 % of systolic blood pressure, 40 % of diastolic blood pressure 80% of weight persons showed stable results. • Deteriorated – 6.6 % of mala baddhata, 6.6 % of systolic B.P. and 6.6 % of diastolic B.P. of persons had shown clinically deterioration at follow up. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 71. - 58 - OBSERVATIONS AND RESULTS Table no-30(a) TABLE SHOWING THE STATISTICAL RESULTS OF GROUP-A Subjective Parameters Variable Gradin Mean SD t P Value Significance g Agni mandya BT 2.000 0.5345 4.0359 0.0004 HS AT 1.2667 0.4577 BT 2.000 0.5345 2.4773 0.0195 S FU 1.466 0.6399 Mala BT 1.8667 0.3519 4.7579 0.00005 HS Baddhata AT 1.2000 0.4140 BT 1.8667 0.3519 2.9283 0.0067 HS FU 1.4000 0.5071 Indriya BT 2.0667 0.5936 1.7222 0.0961 NS kshaya AT 1.2667 0.4577 BT 2.0667 0.5936 0.9845 0.3333 NS FU 1.8667 0.5164 Nidra Nasha BT 2.2000 0.5606 2.7792 0.0096 S AT 1.6667 0.4880 BT 2.2000 0.5606 1.1456 0.2616 NS FU 2.0000 0.3780 Bala Kshaya BT 2.0000 0.5606 1.8709 0.0719 NS AT 1.8000 0.4140 BT 2.0000 0.0000 1.4676 0.1534 NS FU 1.8667 0.3519 Grahana BT 2.1333 0.3519 1.3416 0.1905 NS Kshaya AT 1.9333 0.4517 BT 2.1333 0.3519 1.0000 0.3259 NS FU 2.0000 0.3780 Shwasa BT 2.3333 0.4880 1.5811 0.1251 NS AT 2.0000 0.6547 BT 2.3333 0.723 0.9625 0.3440 NS FU 2.1333 0.6399 Sarvakriya BT 2.0667 0.2582 1.3416 0.1905 NS aswasamarth AT 1.8667 0.5164 BT 2.0667 0.2582 0.9826 0.3342 NS FU 1.9333 0.4577 A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 72. - 59 - OBSERVATIONS AND RESULTS Table no- 30(b) TABLE SHOWING THE STATISTICAL RESULTS OF GROUP-A Objective Parameters Grading Mean SD t P Value SignificanceVariable Blood BT 142.4000 10.6422 0.9296 0.3605 NS Pressure AT 138.9333 9.7649 (Systolic) BT 142.4000 10.6422 0.4789 0.6357 NS FU 140.6667 9.1235 Blood BT 102.6667 5.7900 1.4167 0.1676 NS Pressure AT 98.7333 5.5481(Diastolic) BT 102.6667 5.7900 1.8970 0.0680 NS FU 99.0667 4.5272 Weight BT 52.8333 7.7496 0.1397 0.8899 NS AT 52.2333 7.9347 BT 52.8333 7.7496 0.0922 0.9272 NS FU 53.1000 8.0936 Hb% BT 11.0533 1.3469 0.3568 0.7240 NS AT 11.2400 1.5141 Visual BT 3.1333 2.8999 0.3332 0.7414 NSAcuity(Rt.) AT 2.8000 2.5690 Visual BT 3.3333 2.4976 0.3053 0.7624 NSAcuity(Lt.) AT 3.0667 2.2824 A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 73. - 60 - OBSERVATIONS AND RESULTS Table no-31(a) TABLE SHOWING THE STATISTICAL RESULTS OF GROUP-B Subjective Parameters Variable Gradi Mean SD t P Value Significance ng Agni mandya BT 2.0667 0.2582 3.5777 0.0013 HS AT 1.5333 0.5164 BT 2.0667 0.2582 2.8062 0.0090 S FU 1.6667 0.4880 Mala BT 2.0667 0.5936 2.3150 0.0282 S Baddhata AT 1.6000 0.5071 BT 2.0667 0.5936 0.9845 0.3333 NS FU 1.8667 0.5164 Indriya BT 2.1333 0.5164 6.1980 0.000001 HS kshaya AT 1.1333 0.5164 BT 2.1333 0.5164 4.3611 0.0002 HS FU 1.1333 0.4880 Nidra Nasha BT 2.0667 0.5936 4.6378 0.00007 HS AT 1.2000 0.4140 BT 2.0667 0.5936 2.6253 0.0139 S FU 1.5333 0.5164 Bala Kshaya BT 2.0000 0.0000 6.2048 0.000001 HS AT 1.2667 0.4517 BT 2.0000 0.0000 3.5000 0.0016 HS FU 1.5333 0.5164 Grahana BT 2.4000 0.5071 7.0993 0.0000001 HS Kshaya AT 1.2000 0.4140 BT 2.4000 0.5071 4.4272 0.0001 HS FU 1.4667 0.6399 Shwasa BT 2.4000 0.5071 3.5072 0.001364 HS AT 1.1333 0.6324 BT 2.4000 0.5071 2.8548 0.00803 S FU 1.6667 0.5163 Sarvakriya BT 2.2000 0.4140 4.7329 0.00006 HS aswasamarth AT 1.4000 0.5071 BT 2.2000 0.4140 3.2278 0.0032 HS FU 1.6667 0.4880 A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 74. - 61 - OBSERVATIONS AND RESULTS Table no- 31(b) TABLE SHOWING THE STATISTICAL RESULTS OF GROUP-BObjective Parameters Gradi Mean SD T P Value SignificanceVariable ngBlood BT 136.4000 9.5379 4.0078 0.0004 HSPressure AT 125.2000 5.1158(Systolic) BT 136.4000 9.5379 2.8242 0.0086 S FU 128.5333 5.0408Blood BT 98.0000 5.5549 3.9901 0.0004 HSPressure AT 90.6667 4.4500(Diastolic) BT 98.0000 5.5549 2.7711 0.0098 S FU 92.4000 5.5136Weight BT 52.0000 7.6850 0.4100 0.6849 NS AT 53.1333 7.4510 BT 52.0000 7.6850 0.3762 0.7096 NS FU 53.0333 7.3545Hb% BT 11.6533 1.1843 1.6833 0.1034 NS AT 12.4000 1.2444Visual BT 3.7333 3.0582 0.1206 0.9048 NSAcuity(Rt.) AT 3.6000 2.9952Visual BT 5.5333 2.9729 0.0614 0.9515 NSAcuity(Lt.) AT 5.4667 2.9729 A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 75. - 62 - OBSERVATIONS AND RESULTSCOMPARISION OF RESPONSE OF INDIVIDUAL SYMPTOM AT THE ENDOF TREATMENT AND POST TREATMENT FOLLOWUP IN GROUP A AND B AGNIMANDYA Graph no-23, 24 Agnimandya After Treatment Agnim andya at follow up 9 9 11 10 12 10 8 8 6 NO. OF PERSONS NO. OF PERSONS 7 8 6 5 6 4 4 4 1 2 0 0 2 0 0 0 0 0 0 0 0 0 0 0 CD CS CI- 1 CI- 2 CI- 3 CD CS CI-1 CI-2 CI-3 GR OU P - A 1 5 9 0 0 GROUP-A 0 4 11 0 0 GR OU P - B 0 9 6 0 0 GROUP-B 0 7 8 0 0 GROUP-A GROUP-B GR OU P - A GR OU P - B MALABADDHTA Graph no– 25, 26 Malabaddhata at follow up Malabaddhata after treatm ent 10 10 10 10 8 9 8 9 7 7 8 8 NO. OF PERSONS NO. OF PERSONS 7 7 6 5 6 4 5 5 4 4 3 3 2 2 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 CD CS CI-1 CI-2 CI-3 CD CS CI-1 CI-2 CI-3 GROUP-A 0 5 10 0 0 0 8 7 0 0 GROUP-A GROUP-B 0 8 7 0 0 0 10 4 0 0 GROUP-B GROUP-A GROUP-B GROUP-A GROUP-B A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 76. - 63 - OBSERVATIONS AND RESULTS INDRIYA KSHAYA Graph no-27,28 Indriya kshaya at follow up Indriya kshaya at follow up 12 12 12 12 10 8 10 8 NO. OF PERSONS NO. OF PERSONS 8 8 5 5 6 6 3 3 4 2 4 2 2 0 0 0 0 2 0 0 0 0 0 0 0 0 CD CS CI-1 CI-2 CI-3 CD CS CI-1 CI-2 CI-3 GROUP-A 0 12 3 0 0 GROUP-A 0 12 3 0 0 GROUP-B 0 5 8 2 0 GROUP-B 0 5 8 2 0 GROUP-A GROUP-B GROUP-A GROUP-B NIDRA NASHA Graph no – 29,30 Nidranasha at follow up Nidra nasha after tream ent 12 11 12 12 10 8 10 8 NO. OF PERSONS 7 NO. OF PERSONS 7 8 8 6 6 3 4 3 1 4 2 0 0 0 0 0 0 0 2 0 0 0 0 0 CD CS CI-1 CI-2 CI-3 0 CD CS CI- 1 CI- 2 CI- 3GROUP-A 0 7 8 0 0 0 3 11 1 0 GR OU P - A 0 12 3 0 0GROUP-B GR OU P - B 0 7 8 0 0 GROUP-A GROUP-B GR OU P - A GR OU P - B A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 77. - 64 - OBSERVATIONS AND RESULTS BALA KSHAYA Graph no – 31, 32 Bala kshaya after tretm ent Bala kshaya at follow up 12 11 13 14 12 12 10 NO. OF PERSONS 10 8 7 NO. OF PERSONS 8 8 6 4 6 3 4 4 2 0 0 0 0 2 0 0 0 2 0 0 0 0 0 0 0 CD CS CI-1 CI-2 CI-3 CD CS C I- 1 C I- 2 C I- 3 GROUP-A 0 12 3 0 0 G R O U P- A 0 13 2 0 0 GROUP-B 0 4 11 0 0 G R O U P- B 0 8 7 0 0 GROUP-A GROUP-B GROUP-A GROUP-B GRAHANA KSHAYA Graph no – 33, 34 Grahana kshaya after treatm ent Grahana kshaya at follow up 12 10 13 12 12 14 10 12 NO. OF PERSONS NO. OF PERSONS 10 8 8 6 4 6 3 4 4 2 2 1 1 2 0 0 0 0 0 2 0 0 0 0 0 0 0 CD CS CI- 1 CI- 2 CI- 3 CD CS CI-1 CI-2 CI-3 GR OU P - A 0 12 3 0 0 GROUP-A 0 13 2 0 0 GR OU P - B 0 1 10 4 0 GROUP-B 0 2 12 1 0 GR OU P - A GR OU P - B GROUP-A GROUP-B A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 78. - 65 - OBSERVATIONS AND RESULTS SHWASA Graph no – 35, 36 Response on Shwasa after treatment Response on Shwasa at follow up 12 12 11 12 10 10 8 10 7 NO. OF PERSONS 8 NO. OF PERSONS 8 5 6 6 4 3 4 4 2 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 CD CS CI- 1 CI- 2 CI- 3 CD CS CI- 1 CI- 2 CI- 3GR OU P - A 0 10 5 0 0 GR OU P - A 0 12 3 0 0GR OU P - B 0 4 11 0 0 GR OU P - B 0 7 8 0 0 GR OU P - A GR OU P - B GR OU P - A GR OU P - B SARVAKRIYA ASWASAMARTH Graph no – 37,38 Response on Sarvakriya asw asam arth Response on Sarvakriya asw asam arth after treatm ent at follow up 12 12 13 12 14 12 10 10 8 NO. OF PERSONS NO. OF PERSONS 8 7 8 6 6 3 3 4 4 2 2 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 CD CS CI-1 CI-2 CI-3 CD CS CI-1 CI-2 CI-3 GROUP-A 0 12 3 0 0 GROUP-A 0 13 2 0 0 GROUP-B 0 3 12 0 0 GROUP-B 0 7 8 0 0 GROUP-A GROUP-B GROUP-A GROUP-B A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 79. - 66 - OBSERVATIONS AND RESULTS SYSTOLIC BLOOD PRESSURE Graph no – 39,40 Response on Systolic B.P. after treatm ent Response on Systolic B.P. at follow up 9 8 9 8 8 6 6 7 6 6 7 6 5 5 NO. OF PERSONS 6 NO. OF PERSONS 5 5 3 3 4 4 3 3 2 2 2 1 0 0 1 0 0 0 0 1 0 0 0 CD CS CI-1 CI-2 CI-3 0 CD CS CI-1 CI-2 CI-3 GROUP-A 0 9 6 0 0 GROUP -A 2 8 5 0 0 GROUP-B 0 6 6 3 0 GROUP -B 1 5 6 3 0 GROUP-A GROUP-B GR OU P -A GROUP -B DIASTOLIC BLOOD PRESSURE Graph no – 41,42 Response on diastolic b. p. after Response on diastolic b. p. at follow up treatm ent 10 10 8 12 11 8 6 NO. OF PERSONS 10 7 6 NO. OF PERSONS 8 6 4 4 6 4 1 1 4 2 2 0 0 0 2 0 0 0 0 0 0 0 CD CS CI-1 CI-2 CI-3 0 CD CS CI-1 CI-2 CI-3 1 10 4 0 0 GROUP-AGROUP-A 0 11 4 0 0 GROUP-B 1 6 8 0 0GROUP-B 0 6 7 2 0 GROUP-A GROUP-B GROUP-A GROUP-B A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 80. - 67 - OBSERVATIONS AND RESULTS WEIGHT Graph no – 43,44 Response on w eight after treatm ent Response on w eight at follow up 14 14 14 12 14 12 12 12 10 10 NO. OF PERSONS NO. OF PERSONS 8 8 6 6 3 3 4 4 1 1 0 0 0 0 2 0 0 0 2 0 0 0 0 0 0 0 CD CS CI- 1 CI- 2 CI- 3 CD CS CI- 1 CI- 2 CI- 3GR OU P - A 0 14 1 0 0 GR OU P - A 1 14 0 0 0GR OU P - B 0 12 3 0 0 GR OU P - B 0 12 3 0 0 GR OU P - A GR OU P - B GR OU P - A GR OU P - B HEAMOGLOBIN Graph no – 45 Response on Heamoglobin after treatment 13 14 12 NO. OF PERSONS 8 10 7 8 6 4 1 1 0 0 0 0 2 0 0 CD CS CI-1 CI-2 CI-3 GROUP-A 1 13 1 0 0 GROUP-B 0 8 7 0 0 GROUP-A GROUP-B A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 81. - 68 - OBSERVATIONS AND RESULTS VISUAL ACUITY Graph no – 46,47 Response on Visual acuity (Rt.) after treatm ent 13 14 12 10 10 NO. OF PERSONS 8 5 6 2 4 0 0 2 0 0 0 0 0 CD CS CI- 1 CI- 2 CI- 3 GR OU P - A 0 10 5 0 0 GR OU P - B 0 13 2 0 0 GR OU P - A GR OU P - B Response on Visual acuity(Lt.) after treatment 12 12 11 10 NO. OF PERSONS 8 6 4 4 2 1 2 0 0 0 0 0 0 CD CS CI- 1 CI- 2 CI- 3 GR OU P - A 0 11 4 0 0 GR OU P - B 1 12 2 0 0 GR OU P - A GR OU P - B A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 82. - 69 - Discussion DISCUSSIONTITLE The dissertation entitled ‘A comparative clinical study on Jara with respect toaging process with Amalaki and Ashwagandha Churna’ as individual drug inmaintenance of healthy aging. The problem of aging is global one. The demography of India shows that, thepresent number of senior citizens is 65 millions but is expected to cross 177 millionby the year 2025. It indicates that with increased health care facility and standards ofliving , the death rate of young people has decreased and at same time it has a largeno. of people in the period of old age. As the age advances, the incidence of chronic and degenerative diseaseincreases and the incidence of morbidity is higher. Health care services are thus anecessity for the aged, being the most valuable group.The process of aging may not be reverted but can be postponed for aiming to achieve‘Longer life with lesser disease and ‘Healthy aging’. In Ayurvedic science, Jara Chikitsa has been developed as a specialization, thepractice and health care facilities for elderly, the branch was supreme in ancient past.But in the present days the achievement of this branch is unsatisfactory. From thebook ‘Research in Ayurveda’ by DR. M.S Bhagel it is evident that in India, studiesconducted regarding aging is few. The drugs Amalaki and Ashwagandha are used as the traditional medicinessince time unmemorable for their unique properties like antioxidant, anti Aging etc.Ayurvedic classics have also given the priority to these drugs, that’s why these drugshave been taken for the present study. From the above notation, this study wasundertaken to observe the Healthy Aging effects of Vayasthapana and Rasayana drugs A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 83. - 70 - Discussionin elderly, in terms to provide active longevity, free from disability and functionaldependence.TYPES OF AGING In the context of types of aging Jara can be considered as Kalaj Jara andAkalaj Jara. In another aspect Sukhayu and Dukhayu. This can also be interpretated asnatural and premature. Sukhayu and Kalaj Jara as the name suggests are healthyaging, normal ageing lived by a person who follows all the pathya and apathya or itcan be said that it is the aging followed by maximum physiological changes andminimum pathological changes. But Dukhayu and Akalaj Jara are inevitable ageing,unhealthy in nature and it is due to not following the pathya and apathya .Jara is the commencement of deterioration of body at particular stage of life but somesays that it starts from the childhood only. Ashtang Sangrah and Sharangdhara havementioned declining of Shareer bhava at various decades of life. Factors mentionedare true today also and proved according to modern science.NIDANA Now it is evident that Jara is of 2 types i.e. natural and premature. There areparticular etiologies for premature aging but no separate etiology mentioned in theclassics for natural aging, why because it is naturally occurring phenomenon. Even inmodern science, in spite of so much advancement the reason for this is not known.This makes us to analyze some points which are responsible for Jara. They can beanalyzed as follows, by considering the classics.Factors responsible for Jara are: 1. Swabhava (Natural factor) 2. Kala (Time factor) 3. Vata dominant stage 4. Shareera Vruddhikara bhava – abhava (Depletion of growth factor) A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 84. - 71 - DiscussionSwabhava (Natural factors): - Jara is one amongst the Swabhava bala pravritta vyadhi, Swabhava means;Swabhava shabdhena adrustham ucchate (Chakrapani, Ch. Sha 6/12)Swabhavam Sarvasya Prakruti Karanamoochuhu (Dalhana. Su. Sha 1/4)i.e., the invisible, nature’s unique process can be called as Swabhava. Charaka in hisswabhavoparamavada explains that “there is a causative factor for the manifestationof beings but no causative factor as such exists for their deterioration”. That meansthe process of deterioration occurs naturally. Thus Swabhava can be considered as a responsible factor in the causation ofJara (aging) which is deteriorating, invisible and nature’s unique process.Kala (Time factors): - Kalasya parinamena Jaramrityu nimittajaha… (Ch. Sha 1/115)Charaka explains that Jara is a phase of life that occurs by the effect of time (Kala)Adhamalla, the commentator of Sharangadhara samhita opines: “Kalamiti mrutyu sameepam nayati iti kalam” (Adhamalla,Sha,PrKha 5) thefactor which takes to the end of life i.e. kala. Charaka also has given Nityaga as asynonym for ayu which means the continuous process of growing older. Here alsotime factor is the responsible for nityaga, thus it can be summarized as, the growthand senescence occurs naturally as time passes, kala is accepted as responsible factorfor Jara.Vata: - Charaka while explaining Sankhya Shareera explains that, the body is made upof paramanus (billions of cells of numerous types) which are Atibahu (innumerable).Atisookshma (microscopic) and Atindriya. Chakrapani commenting on the abovereference explains that, these paramanu’s (cells) undergo the process of Samyoga. i.e.fertilization, multiplication and specialization into various organs and physiological A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 85. - 72 - Discussionsystems of the life of human individual begins. And beginning of viyojaka karma ofthese paramanu’s i.e. slowing down of growth and replacement of cells bring out thedeterioration of senescence (Vinasha) 36. (Ch. Sh 7/17) Chakrapani further opines that this process occurs naturally with the help offunctional unit of vata because the samyoga and viyoga are the functions of vata. Here nature (swabhava) is the responsible factor for the functioning of vata.Shareera Vruddhikara bhava abhava (Depletion of growth factors):-Human life span can be broadly divided into 2 phases i.e. growth and senescence.Charaka mentioned 4 factors, the presence of which represents the growth, where asthe absence representing the senescence. These are as follows .37(Ch Sh. 6/12) • Kala yoga (time bounded phenomenon)Chakrapani says that, upto the age of 70, the youth phase itself is the time boundedfactor (i.e.kalayoga) which enables the body to attain growth. Exactly opposite to theabove, the body attains senescence (after the age of 70) leading top senility.Charaka, considered the age up to 30 as growth period and senescence after the age of60, Where as Sushruta, considered growth up to the age of 20, maturity (sampoornata)up to 40, senescence 40-70 and senility after the age of 70. • Swabhava samsiddhi (Natural factor)The invisible (adrustha), nature’s unique process which is responsible factor for bothgrowth and senescence of the body. • Ahara sausthava (diet factor)Diet is possibly the most important factor in controlling the ageing process and evenin its onset. 38 Charaka opines that ahara sousthava / ahara sampat (qualitative aspectof food) is responsible for the proper growth and development of the body .Where asthe Matra Ahara (quantitative aspect of food and caloric limitation) is responsible for 39healthy ageing (Sukhayu) and longevity (Dheergayu) . (Ch. Su. 5/8). It can be A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 86. - 73 - Discussionassumed that opposite to the above diet, produces pathological ageing (Dukhayu) andshortens the span of life (alpayu). • Avighata (Avoiding physical and mental stress)Chakrapani says that for the proper growth and development it is necessary to avoidphysical and mental stress.NIDANA OF AKALAJA JARAIt can be described under three headings. 1. Nidana of Akalaj Jara 2. Etiology of Akalamrityu 3. Factors accelerating aging. These all factors can be summarized asAhara – Improper food Consumption Eating in excess of ones own digestive power Excessive cold intake Avoidance of food and medicineVihara Excessive walking. Irregular posture of the body. Excessive indulgence in sex. Divaswapna.Manoawastha – Bhaya , Krodha, Soka,Lobha ,Moha, and Ayasa , Mental stressOthers Association with wicked persons Non suppression of suppressible urges A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 87. - 74 - Discussion Exposure to injury Exposure to evil spirits (germs), poison, wind and fire.All these factors attributed during charka days are still prevalent today, aiding fasterdegenerations tendencies among the population.POORVAROOPA Poorva roopa are the premonitory symptoms which manifest before thecomplete appearance of the disease. The disease and symptoms which appear earlierto the actual disease are called as “Poorva roopa”Madhava nidana has mentioned Poorva roopa as Shakti ksheenta, Smriti nasha, Glani,Vali palitya, Danta shathilya, and Swabhava parivartana. These symptoms indicateRasa kshaya and Vata prakopa.ROOPA A complete manifestation of a disease in the form of signs and symptoms isknown as roopa. It is the 5th stage of kriya kala where the signs and symptoms of thefully manifested diseases indicates its specific characters like the dominance of thedosha its various stages. Various Ayurvedic classics directly or indirectly havementioned the Roopa of Jara. All the Roopa corresponds to Dhatu kshaya specifically Rasa kshaya and VataPrakopa. Roopa mentioned are present at variable degree at different stages of Jaraaccording to Prakruti, Agni, Bala.The symptoms mentioned are not the cardinalsymptoms but only the supportive factors to diagnose Jara.PROCESS OF AGINGAfter the middle age, biological aging is best characterized by progressiveconstruction of the homeostatic reserve of every organ system. The decline oftenreferred to as homeo stenosis, is evident by 5th decade and is gradual and progressive,although the rate and extent of decline vary. 40 (Chakrapani , Ch. Sha 6/30) A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 88. - 75 - Discussion The life science of Ayurveda explains that, process of senescence begins asnaturally vata attains provocation and it also agrees that the process of aging isgenetically determined. It can be analyzed as follows.Sahaja (Genetic) theoryChakrapani opines that the time of onset of natural aging varies from individual toindividual. It may be delayed in persons having the features of long life span(Dheergayu) whereas early in persons having the features of medium life span(madhyam ayu) and short life span (Avarayu). 41(Chakrapani, Ch. Vi. 8/122)Charaka opines that prakriti guna sampat i.e. constitutional compactness is one of theprime factors required to achieve long life span, which is genetically determined, asexplained by Chakrapani. 40 (Chakrapani , Ch. Sha 6/30)Sarva dhat sara i.e. compactness of all body tissue is another condition where theonset of aging will be delayed i.e. manda jara as explained by Charaka.42(Ch.Vi8/111) The same constitutional compactness is considered as bala byBhavamishra.43(B.P.Rog Prakaran 7/114)Charaka further explains that sahaja i.e. genetically transmission is one of theresponsible factor on which the compactness of body tissues (bala) depends. Tosummarize, the onset and progress of aging depends on the factors like prakriti(constitutional) and sara (compactness of body tissues) which are geneticallypredetermined. Hence the process of aging can be considered as a geneticallypredetermined entity.Sahaja theory seems to be similar to that of programmed aging theory as explained bymodern medical science. It suggests that aging as a predetermined presumably geneticalteration in cellular function that leads to susceptibility to disease and death. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 89. - 76 - DiscussionVatic theory Till middle age (prakrita) vata is responsible for following functions i.e. • Sarva Dhatu vyuhakarata: - Providing compactness of body tissue by assessing the type of nourishment required. 44(Ch. Su.12/4) • Dosha Dhatu agni samata - Maintaining the state of homeostasis of Dosha, Dhatu(body tissues) and Agni(digestive and metabolic activities).45(Su.Ni1/10). • Shareera and Manas kriya: - Keeping the body and mind under sound functional status. 44 • Ayu anuvruttikara : - Maintaining the body elements in normal physiological condition. 44 But as Middle Age passes ,Vata will be provocated naturally and sets in themolecular program of cellular senescence and bring out the following changes. 1. Impaired sarvadhatu vyuhakarata : - The provocated vata becomes unable to provide the compactness to the body tissues, because of faulty assessment of the type of nourishment which is required to the cells. Hence it brings out the formation of Vikrita Dhatus i.e. defective cells, while ultimately resulting in cellular senescence. 2. Rasa shoshana (Errors in nourishing elements) : - The health of an individual is a critical indicator of the body’s nutritional status. It is nutrition, a critical and essential need to the body which has to be satiated for the individual to function normally.46(BP Pu. Kh. 196) Bhavamishra explains that, after the middle age,provocated Vata brings the shoshnata in poshaka rasa i.e. errors in nourishing elements, which results in inadequate nourishment to the tissues and leading to improper Dhatu formation resulting in cellular senescence (dhatukshaya). A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 90. - 77 - Discussion 3. Dhatu asamata : - Sushruta explains that provocated Vata by its shoshana property become responsible for Dhatukshaya.47 (Su.Su.15/36).The same concept is responsible for cellular senescence also, i.e. after the middle age naturally provocated shoshana property of Vata Dosha accumulates in cells (Dhatus) and after reaching a certain levels brings out the Dhatu kshaya i.e. cellular senescence. Sushruta explains that, senescent cells (paripakwa shareeratwa) have decreased capacity for uptake of nutrient (poshaka rasa) to repair of cellular damage. Dalhana commentary on this, adds that, under this state nourishment will be inadequate (ishat) and only maintains minimal cellular functions (Jeevana matram karoti).48 (Su. Su.14/19). 4. Agni asamata : - Charaka explains that sound functional condition of Agni i.e. digestive and metabolic activities are responsible for Ayu bala.49 (Ch. Chi.15/40)i.e. to keep the body and mind under sound functional status and keep the process of cellular senescence to be locked. But after the middle age naturally Agni mandyata occurs, which results in improper cellular formation (Vikruta Dhatu) by improper digestive and metabolic activities, which ultimately resulting in cellular senescence. 5. Mano vyaharsha : - Prakrita Vata is responsible for all mental functions i.e. niyanta, preneta cha. manasa, but provocated vata decreases the mental functions i.e. manovyaharshata.5 0 (Ch. Su 12/8) 6. Ayu upaghata (cellular senescence) : - It is one of the functions of provocated vata i.e. by opening the lock of process of cellular senescence brings out the ayu upaghata. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 91. - 78 - Discussion 7. Oja kshaya : - Oja is responsible for shareera sthairya i.e. compactness of body elements by providing adequate nutritional defense against body elements.Oja will be nourished by Anna rasa (nutrients). In old age agnikshaya, dhatu kshaya and errors in nourishing elements leads tothe state of Ojakshaya i.e. inadequate nutritional defuse against body elements thatleads to the molecular cellular injury to cells, exceeds their repair capacity this furtheraccelerating the aging process ultimately ending in death. According to modern science, although a number of theories have beenproposed to explain the mechanism of aging, it is now clear that all aging is multifactorial. It involves an endogenous molecular program of cellular senescence as well ascontinuous exposure throughout life to adverse exogenous influences leading toprogressive encroachment on the cells survivability so called wear and tear, In thisscenario molecular injury to cells exceeds their repair capacity, this accelerating theaging process. Some of the important theories have been proposed to explain the causesof aging are – On keen observation it seems that the above said modern and ayurvedic theories have got some similarities as followsTheories Similarity1) Impaired dhatu vyuhakarata and gene Faulty assessment of nutrition to the cell.regulation and genetic instability theory.2) Rasa shoshana and error theory. Errors in nourishing elements.3) Dhatu asmata and somatic mutation theory, Unusual changes occurring in the cell.other protein i.e. collagen changes theory.4) Agni asmata and free radical theory, age Metabolic impairment.pigment theory.5) Mano – vyaharsha – enzymatic theory of Diminished mental functions.decreased learning and memory. Responsible for growth, development and6) Ayu anuvrutti and hormonal theory. senescence.7) Dhatus and agni asamata and cross linker’s Cellular, enzymatic etcchanges.8) Ojakshaya and immune response Susceptibility to disease and death. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 92. - 79 - DiscussionSchematic representation of process of Aging Sahaja hetu (Genitical predetermination) Natural provocation of vataImpaired dhatu Rasa Dhatu Agni Mano Ayuvyuha karata Shoshana Asamata Asamata Vyaharsha upaghata Ojakshaya Jara – Cellular senescence Mrutyu – death.The Ayurvedic concept of ageing: - The definition of Ayurveda itself denotes that it is the knowledge of variousaspects of life processes, ageing being one of them.The process of ageing as seen by Ayurveda: - Transformation is the hallmark of time, everything that is living undergoesvarious changes before it is worn completely – This cycle of changes is known inAyurveda as ‘Parinama’ which takes place under the constant influence of “Kala” ofthe time factor. In other words, Kala is responsible for parinama. In this context,parinama being ageing, the sequential events of Balya, Tarunya youvana, Proudha,Vardhikya are all consequential eventualities of kala. Therefore, Ayurveda recognized kala or parinama as the potential causativefactor of degenerative disease entities. Jara being a swabhavabala pravrutta roga occurs due to the above mentionedvyadhi hetu kala / parinama. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 93. - 80 - Discussion The effect of time is bound to happen and is “Nishpratikriya” i.e. unavoidablehowever if one adheres to certain modes of life, one can expect smooth sailing. Thesame is stressed by Chakrapani, while commenting or whether lifespan of anindividual is predetermined. He compared the human body to a Ratha(chariot), thefull lifespan of the Ratha is subject to its proper maintenance or lubrication as well asthe conditions of the roads it has traverse. Otherwise it is bound to deteriorate early.He interpretated that the Ayu is not predetermined but is dependent on variousendogenous and exogenous factors that interplay in the human body. The componentof Ayu, are shareera, Indriya, Satwa and Atma. Atma is a supreme entity, immune tothe cycle of birth, death and disease (Nirvikara Parstu atma).The other 3 componentsof Ayu i.e.1. Shareera 2. Indriya 3.Satwa along with the vikruti that fall within the scope, beingtaken into considerations.It can be pointed out that there is no single and complete concept on the agingprocess in modern medicine. Different theories have been put on Jeevaparamanus i.e.Dhatus, srotases, malas, indriyas, which are under constant interaction with theTridoshas. In the context of jarajanyavikaras: Vatadosa is predominant; pitta is irregular while Kapha is in a depleted state.This cascade of events targets the ‘vyadhikshamatva’ as well as satwa of the vriddha,submerging him in diseases. DISCUSSION OF MATERIALS AND METHODSMaterialsAmalaki ChurnaAshwagandha churna A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 94. - 81 - DiscussionCRIETERIA FOR SELECTION OF DRUGAmalaki Churna – Amalaki has been mentioned as the best Rasayana Drug andVayasthapana Drugs in Ayurvedic classics. It has been also proved that it containsrich Vit. C which is a best antioxidant. It is a cheap, easily available, easy to prepare,does not contain any harmful medicinal values, economical than other drugs.Ashwagandha churna – It is the drug proved to be having excellent medicinal valuesand found to be very effective as Rasayana drugs. So the above drug has been takenfor trial. It is proven to be effective in old age, cheap and no harmful medicinalvalues.METHODSAIM – A comparative clinical study on Jara with respect to aging process withAmalaki and Ashwagandha ChurnaThe present study was to know the efficacy of Amalaki and Ashwagandha Churna asindividual drug and to compare their efficacy in Jara. As the statement regardingAshwagandha seems quite encouraging towards providing a better result in Jaraawastha.Study designThe present study was a comparative single blind study. Persons were incidentallyselected with a predetermined randomization technique and were assigned into twogroups viz; Group-A and Group-B.Selection of PatientsIn the present study 30 persons were selected from O.P.D and Camps conducted byDr. BNMET’s Shri. Mallikarjun Swamiji Post Graduate and Research center, Bijapur,full filling the diagnostic criteria irrespective of cast, socio-economic status, etc, forthe study to avoid bias. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 95. - 82 - DiscussionInclusion and Exclusion criteriaPersons with classical signs and symptoms of Jara awastha were considered forinclusive criteria, as it is main source in selection of persons.Age criteriaIn aspect of old age there is a controversy in our classics in starting of Jara awastha,some have considered as above 60 and some as above 70. But according to presentcondition and average life span and standards of W.H.O. 60 yrs and above age groupwith classical signs and symptoms of Jara were included.Exclusion criteriaThe study excludes systemic disorders and the persons with complete disabilities .SamplingA predetermined sampling method was adopted; where in 15 cards were marked asGroup-A and 15 cards Group-B. A neutral person was asked to pick up the cards oneby one. The groups marked on the cards against each pick up card were recordedserially from 1 to 30. After every pickup the cards were shuffled. The persons selectedincidentally were assigned with serial number from 1 to 30. Thus the personscorresponding particular group which was in an order were treated accordingintervention of particular group. The technique was adopted in order to avoid thesampling bias.ASSESSMENT OF VARIABLEFrequency of attacks of each symptom gives an idea about the severity of disease. Soin this study the presentation from each patient was collected against each variableand graded as prakruth 1, mradu 2, madhyam 3, teevra 4,grading for all the variablesand mode of grading are tabulated and presented along with clinical Performa,specially formatted for present study. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 96. - 83 - Discussion DISCISSION ON OBSERVATIONSAge As per our Ayurvedic literature Jara awastha is usually seen in age after60years, accordingly the inclusive criteria was fixed between 60-70-yrs of age.In the present study it was observed maximum persons were found between the age61-65 yrs of age i.e.18 (60%) and between the age 66- 70 yrs age were 12(40%).Hence from the following observations it can be stated that population of old personsis more in the age group 61-65yrs than in the age group 66-70yrs and as the ageadvances severity of symptoms increases.Sex In the present study it was observed that Male persons were more i.e.20(66.6%), where as female persons not too less i.e.10 (33.4%). According to this studypredominancy of old male persons over female old persons can be hyothised.Religion The distribution of persons according to religion showed that, the 24 personsi.e.80% were Hindus and 6 persons i.e. 20% were of Muslim religion. This datashows the predominancy of Hindus over Muslims in the study area, but there are nospecific variations in signs and symptoms of Jara awastha according to religion.Occupation The persons from various occupations were observed for the study. Amongthem majority were Farmers i.e.11 persons (36.6%), Housewife 09 persons (30%),Business 03 (10%), persons with retired life 07(23.4%). This shows that the mainoccupation of the persons in this area is agriculture. Particular occupation may becontributing factors for Akalaj Jara. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 97. - 84 - DiscussionSocioeconomic status In the present study maximum persons observed were of Poor class i.e. 18persons (60%) while, middle class persons were 12 (40%) each. There are no suchvariations in Jara awastha related to socioeconomic status according to classics. Butsometimes according to type of life style, area of residence and work may affect theJara stage.Food Habit Among the persons observed for study vegetarians were 20 persons (66.7%)and those who took mixed diet were 10 persons (33.3%).There is no such effects seenon Jara awastha according to types of food habits because they differ from person toperson and depends on their Prakruti also. But it is commonly seen that non veg. foodis rich in vitamins, proteins and minerals.Habits Almost all the 30 persons were found to have one or the other habit. Amongthem maximum were in the group of tea consumption and tabacoo chewing. Thesehabits are responsible to achieve premature aging and also responsible for aggravatingthe symptom as the age advances.Prakruti pradhanata Majority of the observed persons were of Vata pradhana Prakruti i.e. 14persons (46.6%), with Pitta and Kapha 08 persons each i.e. (26.7%) each. As Jaraawastha is vata predominant stage, signs and symptoms of Jara awastha are seenearlier or are more define in Vata pradhana Prakruti persons as compare to otherPrakruti persons.Systolic Blood Pressure It was observed that the systolic B.P. of majority of old persons was between122-140 mm. of Hg. i.e. 16 persons (53.4%) and least in the group of 100-120mm of A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 98. - 85 - DiscussionHg. i.e. 02 (6.6%) and in the group of 142-160 mm. of Hg., there were 12 persons(40%). i.e. majority of persons reported with Blood Pressure reading more than thenormal. There is increase in systolic blood pressure as the age advances.Diastolic Blood Pressure It was observed that the Diastolic B.P. of majority of old persons was between91-100 mm. of Hg. i.e.16 persons(53.3%) and least in the group of 82-90mm of Hg.i.e. 04 (13.3%) and in the group of 101-110 mm. of Hg. there were 10 persons(33.4%). Slight increase was found in diastolic blood pressure also. This may beexplained on the basis of physiological changes taking place as the age advances e.g.Atherosclerosis.Weight Weight of persons depends on many physiological, pathological, andenvironmental factors. It was observed that the Weight of majority of old persons wasbetween 40-50kg. i.e.16 persons (53.3%) and moderate in the group of 50-60kg i.e.12(40%) and least in the group of less than 40kg. i.e. 02(6.6%). In this studymaximum persons were found below normal weight. This may be due to the type ofland, environment they are living. And many other general factors such associoeconomic status may be responsible for above fact.Haemoglobin Among the 30 persons majority of the persons 18(60%) were having Hb%between 10- 12gm%. Between 12-14gm% there were 08(26.7%) persons and between08- 10gm% there were least no. of persons i.e. 04(13.3%). Hemoglobin depends uponmany factors e.g. Food habits, physiological factors and environmental factors. In thisstudy maximum persons were from rural area i.e. they are mainly dependent onunprocessed food , this may be the reason that much low level of hemoglobin was notfound in any persons. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 99. - 86 - DiscussionVisual AcuityThis parameter was taken as an observational in my study. Very few persons werehaving normal visual acuity and most of them have undergone Intra Ocular Lenstransplantation surgery. DISCUSSION ON RESULTSAGNI MANDYA Persons of both the group A and B had shown significant results in thetreatment of Agnimandya .Group A is having t value 4.0359 AT and 2.4773 atFU.Group B is having t value 3.5777 AT and 2.8062 at FU.But if we compare boththe results then Group A shows better results than Group B.MALA BADDHATA For this parameter Group B has not shown such significant result as shown byGroup A. Group A is having t value 4.7579 AT and 2.9283 at FU. Group B is having tvalue 2.3150 AT and 0.9845 at FU.INDRIYA KSHAYA Persons of Group B have shown significant results as compared to GroupA.The t value for Group A is 1.222 AT and 0.9845 at FU. The t value for Group B is6.1980 AT and 4.3611 at FU.NIDRA NASHA Persons of Group B have shown significant results as compared to Group A.Group A has t value 2.7792 AT and 1.1456 at FU. Group B has t value 4.6378 AT and2.6253 at FU.BALA KSHAYAThe t value of both groups clearly indicates that Group B has shown significantresults. The value of t in Group A is 1.8709 AT and 1.4676 at FU and t value in groupB is 6.2048 AT and 3.5000 at FU. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 100. - 87 - DiscussionGRAHANA KSHAYAThe results shown for grahana kshaya by Group B are significant as compared toGroup A. The t value for Group A is 1.3416 AT and 1.0000 at FU and t value forGroup B is 7.0993 AT and 4.4272 at FU.SHWASAPersons of Group B have shown significant results as compared to Group A.Group A having t value 1.5811 AT and 0.9625 at FU and Group B having t value3.5072 AT and 2.8548 at FU.SARVAKRIYA ASWASAMARTHPersons of Group B has shown significant results as compare to Group A.The t value for Group A is 1.3416 AT and 0.9826 at FU. The t value for Group B is4.7329 AT and 3.2278 at FU.BLOOD PRESSURE (SYSTOLIC)Group B has shown significant result for systolic B.P. as group A has shown nonsignificant results. The t value for Group A is 0.9296 AT and 0.4789 at FU. The tvalue for Group B is 4.0076 AT and 2.8242 at FU.BLOOD PRESSURE (DIASTOLIC)Group B has shown significant results for this parameter also, where Group A hasshown non significant results. The t value for Group A is 1.4167 AT and 1.8970 atFU. Group B is having 3.9901AT and 2.7711 at FU.WEIGHTBoth the Groups A and B has shown non significant results statistically for thisparameter of study. But slight increase in weight was seen in the persons of group Bafter treatment .HAEMOGLOBINFor this parameter of study slight increase in Haemoglobin percent was seen inmaximum persons in group B as compare to group A. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 101. - 88 - DiscussionVISUAL ACUITYPersons of both the groups have shown no significant result for visual acuity for botheyes for distant vision. The t value is very less in both, AT and at FU in both theGroups. PROBABLE ACTION OF DRUGSPROBABLE MODE OF ACTION OF ASHWAGANDHAAshwagandha by virtue of its rasa, guna, veerya, vipaka and prabhava, promotes,digestion, metabolism, maintains homeostasis of doshas, enriches nourishment andpromotes body and mental functions thus becomes effective in aging.AgniIts tikta, katu – rasa + laghu – guna +ushna _veerya and vatashamaka karmapromotes digestion and metabolism their by production of rasa and elimination oftoxic metabolites and pollutants is achieved.DoshaSnigdha guna +ushna veerya +madhurvipaka +vataghana + rasayan property.-- Vatadosha shamanaDhatuSnigdha guna + madhura vipaka (snigdha +guru) + rasayana + balya + vrushya –dhatu and bala vardhanManaCorrecting Vata + Rasayana (prabhava)+ Medhya property > Does mano PrasannataModern concept Several types of alkaloids are found in the plant of which withenia, somniferaand withasomnine are important in traditional preparations. The alkaloid withaferin isresponsible for the bacteriostatic and anti tumour properties. Recently steroidal factorshave been isolated from leaves. The withanoloids are believed to account for the A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 102. - 89 - Discussionmultiple applications of Ashwagandha. These molecules are steroidal and bear aresemblance, both in their action and appearance to the active constituents of Asianginseng (panax ginseng) known as ginsenosides and are called as Indian ginseng.These serve as important hormones precursors, which the body is then able, as neededto convert into human physiological hormones. If there is an excess of certainhormones, the plant based hormones precursor occupied the so called hormonereceptors sites without converting to human hormones to block absorption . In thisway Ashwagandha like other adoptogenic tonic herbs is amphoteric and can serve toregulate important physiological processes, increasing or decreasing as needed.Generally Ashwagandha stimulates the immune system. It has also been shown to inhibit inflammation and improve memory. Itcounteracts the effects of stress and promotes wellness.PROBABLE MODE OF ACTION OF AMALAKI Amla and Madhur rasa act as Vata dosha shamak .Amla rasa does the Vataanuloman, helps to relieve the Vibhand and sarvanga marda. Katu rasa actsJatharagni Deepak , Ama pachak and Kapha dosha shamak ,as it has the srotomukhavishodhana guna.It destroys the sangh of Rasavaha srotas caused due to theAma kapha. Tikta rasa act as kapha dosha shamaka . As it is one of the nitya sevanaRasayana dravya, it does the dhatu pushti, increases the bala, act as daurbalya nashak.During this study Amalaki has shown good results on the subjective parametersAgnimandya and Malabaddhata.On Agnimandya :Amlapradhana Panch Rasa + Rasayana Property + Vayasthapana gana + Yakrutauttajaka –Agnideepan, vata anuloman. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 103. - 90 - DiscussionOn Mala baddhata:Amla pradhana Panch rasa + Madhura Vipaka + Rasayana Property+Virechanopagagana(Ch.) – Agni deepan, Vata anuloman , Prakruta mala.Modern Concept Amalaki consists of rich amount of Vit. C. Both ascorbic acid and its oxidizedproduct dehydroascorbic acid are biological active. Vit. C precipitates in oxidationreduction reaction and hydrogen ion transfer reaction. As an anti oxidant, Vit. Cdonates electrons to Quench reactive free radicals and oxygen species. It also acts toregenerate other anti oxidants such as Vit. E, Flavnoids and Glutathione. Otheractions of Vit.C include promotion of non heme iron absorption,carnitine biosynthesisand conversion of dopamine to norepinepharine. Vitamin C is also important forconnective tissue metabolism and cross linking and is a component of many drugsmetabolizing enzymes systems, particularly the mixed functions oxidase systems. Assuch vitamin participates in the synthesis of corticosteroids, aldosterone and themetabolism of cholesterol. Vit C also participates in enzymatic reactions requiring areduced metal, although exact molecular basis for this role has not been delineated. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 104. - 91 - CONCLUSION CONCLUSION1) Jara Awastha can be correlated with that of Aging in modern Geriatrics.2) Factors responsible for Kalaj Jara are: a)Swabhava b)Kala c)Vata predominancy d)Shareera Vruddhikara bhava abhava3) Process of Aging depends upon: a) Sahaja Hetu and b) Natural dominancy of Vata.4) There is no particular and complete concept to explain the process of Aging according to modern science till date.5) It is difficult to enumerate all the factors responsible for premature aging in present days due to fast changing civilization.6) Biological age starts much earlier than the chronological age as considered according to literature i.e. above 60 yrs.7) Ashwagandha has got significant effect in treating aging elements to anticipate Healthy Aging.8) According to present study, in comparison to Amalaki, Ashwagandha can be considered as a choice of drug for healthy aging. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 105. 92 FEW WORDS FEW WORDSWith today’s changing life styles and growing prosperity, our urban population mustanswer the very difficult question: How do you look after those who looked after you?We have achieved advancement in every field but lacking in social aspects of healthcare. What this study suggest is that, the prime important thing in old age is not themedicine or technology but the ‘Care’ for which they are in need of. 1. So ‘Greet and Treat’ patients in their home without ever transporting the patients to the hospital, thus taking care of great burden of Medico legal and ethical responsibility. 2. It has been found difficult if not impossible for an old person to be regular for his medicines and follow the advice of the doctor due to physical, mental and social reason. So these trials should be carried under supervisions of care holders like in Old Age Homes etc. 3. Palliative Care should be made mandatory in every aspect of old age. A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 106. - 93 - RECOMMENDATIONS FOR FURTHER STUDY RECOMMENDATIONS FOR FURTHER STUDY In the present study it was observed that it was not possible to touch the depth of all the points. Hence it is the need of time to study many of such things in depth for the betterment of the concepts and for the updating of the concepts. Hence few of the studies recommended are based on the outcome of present work. 1. Further study about the topic is needed to set the advanced Assessment parameter of old age which is the main hindrance in development of this science. 2. Study on Akalaja Jara factors can be elaborated. 3. Study can be taken on a particular aspect of Aging like Skin Aging, Mental Aging, Cardiac Aging etc. 4. Geriatric gynaecology – A new field for study. More patients are coming for repair of prolapse, non specific vaginitis, tumours, psychic aberrations and sexual problems. 5. Last but not the least the following aspects of study can be think over. • Same drugs with different anupana such as milk, ghrita etc. • Different drugs such as Shatavari, Haritaki, Guduchi etc. • Duration of the study may be increased to get better results. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 107. - 94 - SUMMARY SUMMARY The Dissertation entitled ‘A Comparative Clinical study on Jara w.r.t agingprocess with Amalaki and Ashwagandha Churna’ is summarized as under.Health care of Elderly is most neglected part in the health care system withadvancement in medicine. Still there is no effective remedy to provide activelongevity free from disability and functional dependence. Keeping these points inmind these drugs have been chosen for this study. Jara tantra is one among the eight branches of Ayurveda. None of the classicshave described the Jara as a separate vyadhi or as a separate context. From theavailable literature in Ayurveda, the state of Jara has been narrated as SwabhavajaVyadhi or Kalaj avastha vishesh ie. Swabhava is ultimate reason to lead the conditionof Jara. Etiological Factors for Jara have not been mentioned in classics because theyhave considered it as Swabhavaj Vyadhi, which is not having specific cause. But wemay find factors responsible for akalaja Jara in different context in different classics.Next controversial point is the process of aging which has not been describedanywhere. Modern authors have different views regarding the process of aging, theyhave mentioned different theories to describe that. The dissertation work is presented in two parts. The first part deals with thereview of literature on Jara ,its definition, its synonyms , historical review ,types,nidana ,purva roopa, roopa, modern review and various theories to describe theprocess of aging. This is followed by Drug review on Amalaki and Ashwagandha.The second part is related to clinical trials, it includes materials and methods ,observations general and according to individual group, results of the study,discussion and lastly the conclusion. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 108. - 95 - SUMMARY It was single blind comparative clinical study. The study was carried out on 30patients of age group 60 yrs to 70 yrs having signs and symptoms of Jara. The patientswere selected incidentally and assigned into two groups. The data was collected from both the groups before treatment, after 60 daystreatment and after 30 days at post treatment follow up. The observations included incidence of age, sex, religion, occupation, foodhabits, habitat etc. The results were assessed according to assessment criteria and values werecalculated by applying‘t’ test. The study revealed that overall Ashwagandha has significant results ascompare to Amalaki after the treatment of 60 days. Hence it can be concluded thatAshwagandha has got significant properties in treating ageing elements and to achievethe goal of healthy ageing. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 109. - 96 - BIBLIOGRAPHY BIBLIOGRAPHY 1. Dr. Suresh Babu and Dr. M. Madhavi ; Geriatrics in Ayurveda, 1st Edition, Varanasi, Chaukhambha Orientalia 2001 : 11. 2. Bhattacharya Taranath Shabdostoma, Mahanidhi Sanskrit Dictionary, 3rd Edition, Chaukambha Sanskrit Series, Varanasi 1967: 181. 3. Dr. Suresh Babu and Dr. M. Madhavi ; Geriatrics in Ayurveda, 1st Edition, Varanasi, Chaukhambha Orientalia 2001 : 6,7. 4. Mosby’s Medical nursing and Allied Health Dictionary, Edited by Kanneth N Anderson et. al 4th Edition, Pub Mosby. 5. Dr. Suresh Babu and Dr. M. Madhavi ; Geriatrics in Ayurveda, 1st Edition, Varanasi, Chaukhambha Orientalia 2001 : 6,7. 6. Dr. Chaturvedi Gorakhnath and Pd Shastri Kashinath, Charak Samhita of Charaka, Purvardha, Varanasi, Chaukhambha bharati academy, 2001: 781,782. 7. Help age India or research and Development Journal Vol-6 No.3 June September 2000, Qutub Institutional Area New Delhi 16, P - 38. 8. Harrison’s Principles of Internal Medicine, Vol – I, Edited by Eugene Braunwald and others 15th Edition Vol I, P – 38. 9. Prof. K.R.Srikantha Murthy. Sushruta Samhita (English Translation) Part I, Chaukhambha Orientation Varanasi, 2000 : 177. 10. Dr. Chaturvedi Gorakhnath and Pd Shastri Kashinath, Charak Samhita of Charaka, Purvardha, Varanasi, Chaukhambha bharati academy, 2001 : 701. 11. Srikantha Murthi K.R. Astanga Sangraha of Vagbhata, Vol II, 3rd Edition Varanasi, Chaukhambha Orientalia 2001 : 104, 105. 12. Shastri Parashuram, Vidyasagar, Sharangadhar Samhita of Sharangadhar Purvakhandha, 4th Edition, Varanasi, Chaukhambha Orientalia 2002 : 30. 13. Prof. K.R.Srikantha Murthy. Sushruta Samhita (English Translation) Part I, Chaukhambha Orientation Varanasi, 2000 : 177. 14. Dr. Chaturvedi Gorakhnath and Pd Shastri Kashinath, Charak Samhita of Charaka, Purvardha, Varanasi, Chaukhambha bharati academy, 2001 : 701. 15. Dr. Indra Dev Tripathi, Rasratna Samuchchaya of vagbhatacharya, Chaukhambha sanskrit bhavan, varanasi 2003: 347. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
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  • 112. - 99 - BIBLIOGRAPHY 43. Sri Brahmasankar and Sri Rupalalaji Vaisya. Bhavaprakash of Sri Bhava Misra, Roga prakaran, Chaukhambha Sanskrit Samsthana, Varanasi , Edition 8th :1997, 7/114,p 935. 44. Dr. Sharma and Dash ,Agnivesh’s Charaka Samhita , Eng. Translation and critical exposition based on Chakrapani Datta’s Ayurveda Dipika , Chaukhambha Sanskrit Samsthan, Varanasi ,Reprint 2005: p I/237 45. Vd. Jadavji Trikamji Acharya and Narayan Ram Acharya , Susruta Samhita of Susruta with the Nibandh Sangraha Commentry of Dalhanacharya and Nyayachandrika, Chaukhambha Orientalia Varanasi , Edition 8th 2005, p 248. 46. Sri Brahmasankar and Sri Rupalalaji Vaisya. Bhavaprakash of Sri Bhava Misra, purva khanda ,Chaukhambha Sanskrit Samsthana, Varanasi , Edition 8th :1997,3/196,p 61. 47. Vd. Jadavji Trikamji Acharya and Narayan Ram Acharya , Susruta Samhita of Susruta with the Nibandh Sangraha Commentry of Dalhanacharya and Nyayachandrika, Chaukhambha Orientalia Varanasi , Edition 8th 2005, p 74. 48. Vd. Jadavji Trikamji Acharya and Narayan Ram Acharya , Susruta Samhita of Susruta with the Nibandh Sangraha Commentry of Dalhanacharya and Nyayachandrika, Chaukhambha Orientalia Varanasi , Edition 8th 2005, p 64. 49. Dr. Sharma and Dash ,Agnivesh’s Charaka Samhita, Eng.Translation & Critical exposition based on Chakrapani Datta’s Ayurveda Dipika , Chaukhambha Sanskrit Samsthan, Varanasi ,Reprint 2005: pIV/23 50. Dr. Sharma and Dash,Agnivesh’s Charaka Samhita,Eng.Translation & Critical exposition based on Chakrapani Datta’s Ayurveda Dipika,Chaukhambha Sanskrit Samsthan, Varanasi ,Reprint 2005:pI/237. A COMPARATIVE CLINICAL STUDY ON JARAWITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA
  • 113. I ANNEXURE -I CLASSICAL REFERENCES Jara Swabhavika VyadhixuÉpÉÉuÉoÉsÉmÉëuÉרÉÉ: ¤ÉÑÎimÉmÉÉxÉÉeÉUÉqÉ×irÉÑÌlÉSìÉmÉëpÉ×irÉ: |iÉåÅÌmÉ Ì²ÌuÉkÉÉ: - MüÉsÉM×üiÉÉ AMüÉsÉM×üiÉÉ¶É |iÉ§É mÉËUU¤ÉhÉM×üiÉ MüÉsÉM×üiÉÉ: |AmÉËUU¤ÉhÉM×üiÉÉ AMüÉsÉM×üiÉÉ: |8| Susruta Sutrasthana 24 P.P. NidanamÉpSrÉÉqÉÌiÉuÉ aÉqÉlÉålÉ iÉjÉÉÅÌiÉzÉÏiÉ-xÉÇxÉåuÉlÉålÉ cÉ MüS³ÉÌlÉmÉåuÉhÉÉ¶É ||uÉ׮Ʌ¡ûlÉÉxÉiÉiÉxÉÇaÉqÉlÉÉ¶É cÉåiÉÉå SÒ:ZÉÉSÒSåÌiÉ ÌWû eÉUÉ xÉqÉrÉÉ¶É lÉÔlÉqÉç ||1|| MadhavanidanaJararoganidana Parishishta-P.P. 500 Purvaroopa¤ÉÏhiuÉqÉ§É xÉqÉÑSåÌiÉ zÉUÏUz£åüUÉSÉæ ¢üqÉåhÉ iÉSlÉÑ xqÉ×ÌiÉlÉÉzÉ LuÉ |asÉÉÌlÉ xiÉiÉÉåÅAÉårÉuÉrÉuÉåwÉÑ eÉÌlÉoÉïsÉÏlÉÉÇ mÉÉÍsÉirÉqÉirÉÍkÉMüiÉÉå ÌWû ÍzÉUÉåÂWåûwÉÑ ||2||SliÉxrÉ cÉÉÌmÉ ÍzÉÍjÉsÉiuÉqÉjÉ xuÉpÉÉuÉå pÉÑrÉÉlÉç ÌuÉmÉrÉïrÉ CÌiÉ mÉëÌiÉqÉÉlÉuÉÇ uÉæ |mÉëÉrÉÉå eÉUÉÅÅaÉqÉlÉMüÉsÉiÉ LuÉ mÉÔuÉïqÉurÉ£üqÉϤrÉiÉ EAmÉrÉÑïÌSiÉçÇA iÉÑ sɤqÉ ||3|| Madhavanidana Jararoganidana Parishishta-P.P. 500mÉëÉaÉëÑmÉxÉÇMüÍjÉiÉsɤqÉcÉrÉmÉëMüÉzÉÉå u»åû¶É qÉÉl±qÉjÉ xÉÉWûxÉÌWûlÉiÉÉÅ®É |kÉærÉïmÉëhÉÉzÉ EAÂUmrÉÌiÉ xÉçÇzÉrÉ: xrÉÉiÉç xÉÇmÉÉSlÉå rÉÑuÉeÉlÉÉåÍcÉiÉM×üirÉUÉzÉå: ||4||ÍcÉliÉÉ bÉ×lÉoÉWÒûsÉiÉÉ M×üzÉiÉÉÅÌiÉUÉåwÉÉå uÉ×®rÉÉ MüTüxrÉ ÌWû aÉsÉå ÌlÉiÉUÉÇ cÉ xÉÌ£ü: |ÌlɸÏuÉlÉålÉ xÉWû iÉxrÉ cÉ ÌlÉaÉïqÉÉå uÉÉ WûxiÉÉXèûÎblÉqÉkrÉaÉiÉuÉåmÉjÉÑUmrÉeÉx§qÉç ||5||MüqmÉÉåÅÍkÉÎeÉyuqÉÌmÉ cÉ xZÉsÉlÉÇ iÉÔ qÉÔbêlÉ: mÉÉS²rÉxrÉ cÉ kÉlÉÑuÉïSjÉÉaÉëiÉç: xrÉÉiÉç |SåWûxrÉ cÉÉÌiÉlÉqÉlÉÇ ½ÍkÉoÉÑή oÉÉsrÉÇ eÉÉrÉåiÉ cÉÉÌiÉZÉUiÉÉ mÉëM×üiÉÉæ ÌuÉzÉåwÉÉiÉç ||6||uÉÉiÉÉqÉrÉÉÌSMüaÉSÉ ÌuÉÌuÉkÉÉ pÉuÉårÉÑ: xuÉsmÉÅÌmÉ zÉÌ£üUuÉÍzÉwrÉiÉ LuÉç xÉÉåRÒûqÉç |YsÉåzÉÇ cÉ MÇücÉlÉ MüjÉÇcÉlÉ lÉæuÉ SåWåû MüÉxÉxiÉjÉÉ μÉxÉlÉqÉmrȨ́ÉÌuÉxqÉ×ÌiÉ¶É ||7||ShQûÉ´ÉrÉåhÉ aÉqÉlÉ USWûÏlÉiÉÉÅÅxrÉå ÍcÉÀûÉlrÉqÉÔÌlÉ aÉÌSiÉÉÌlÉ eÉUÉåÎijÉiÉÉÌlÉ |uÉæ±Éå¨É qÉæoÉïWÒû ÌuÉÌuÉcrÉç cÉ rÉÉÌlÉ iÉÉÌlÉ ¥åÉrÉÉÌlÉ xÉÇmÉëÌiÉ eÉUÉÅÅM×üÌiÉqÉÏmxÉÑÍpÉuÉæ ||8||xÉimÉjrÉxÉåuÉlÉuÉzÉÉSÌmÉ rÉÑÌlÉ UÉåaÉÉ rÉå rÉÉÎliÉ cÉÉzÉÑ xÉÑZÉxÉÉkrÉSzÉÉqÉuÉzrÉqÉç |iÉå rÉÉmrÉiÉÉÇ SkÉÌiÉ cÉÉ§É ÌWû xÉΊÌMüixÉÉÌlÉ:zÉåwmÉÉSxÉqÉÑmÉÎxjÉÌiÉMüÉsÉ LuÉç ||9|| Madhavanidana Jararoganidana Parishishta-P.P. 500
  • 114. II Vaya and Jara Laxana :uÉrÉxiɶÉåÌiÉ MüÉsÉmÉëqÉÉÎhuÉzÉåwÉÉmÉåͤÉhÉÏ ÌWû zÉUÏUÉuÉxjÉÉuÉrÉÉåÅÍpÉkÉÏrÉiÉå |iɲrÉÉå rÉjÉÉxjÉÔsÉpÉåSålÉ Ì§ÉÌuÉkÉÇ- oÉÉsÉÇ, qÉkrÉÇ,eÉÏhÉïÍqÉÌiÉ |WûÏrÉqÉÉlÉkÉÉÎiuÉÎlSìrÉoÉsÉuÉÏrÉïmÉÉæÂwÉmÉUÉ¢üqÉaÉëWûhÉkÉÉUhÉxqÉUhÉuÉcÉlÉÌuÉ¥ÉÉlÉÇpÉëzrÉqÉÉlÉkÉÉiÉÑaÉÑhÉÇ uÉÉrÉÑkÉÉiÉÑmÉëÉrÉÇ ¢üqÉåhÉ eÉÏhÉïqÉÑcrÉiÉå | Charak Samhita Vimanasthana 8/122xÉmiÉiÉåÂkÉçÇuÉï ¤ÉÏrÉqÉÉhkÉÉÎiuÉÎlSìrÉoÉsÉuÉÏrÉÉåïixÉÉWûqÉWûÌlÉ uÉsÉÏmÉÍsÉiÉZÉÉÍsÉirÉeÉѹÇMüÉxÉμÉÉxÉmÉëpÉ×ÌiÉÍpÉÂmÉSìuÉæUÍpÉpÉÔrÉqÉÉlÉÇ xÉuÉïÌ¢ürÉÉxuÉxÉqÉjÉïÇeÉÏhÉÉïaÉÉUÍqÉuÉÉÍpÉuÉ×¹qÉuÉxÉÏSliÉÇ uÉ×®qÉÉcɤÉiÉå ||29|| Susruta samhita Sutrasthana 35/29iÉiÉxiÉÑ xÉmiÉiÉåÂkuÉï ¤ÉÏhÉkÉÉiÉÑ UxÉÉÌSMü: |¤ÉÏrÉqÉÉhÉåÎlSìrÉoÉsÉ: ¤ÉÏhÉUåiÉÉ ÌSlÉå ÌSlÉå ||47||uÉÍsÉ mÉÍsÉiÉ ZÉÍsÉirÉ rÉÑ£ü: MüqÉïxÉÑ cÉɤÉqÉ: |MüÉxÉ μÉÉxÉÉÌSÍpÉ: ÎYsɹÉå uÉ×®Éå pÉuÉÌiÉ qÉÉlÉuÉ: || Bhavprakash nighantu Purvakhanda 4 (Balprkrana)
  • 115. IV DR. B.N.M.E TRUST’S Shri. Mallikarjun Swamiji Post Graduate & Research Centre, Bijapur. Department of Kaya chikitsa. CLINICAL PROFORMA “ A COMPARATIVE CLINICAL STUDY ON JARA WITH RESPECT TO AGEING PROCESS WITH AMALAKI AND ASHWAGANDHA CHURNA”Rugna Nama : SR.NO. :Vaya : O.P.D NO.Linga : Date :Jati : Group : A/BVyavasaya : Date of Commencement of trial :Vivahita /Avivahita : Date of completion of trial :Samajika avam Arthikastithi :Nivas : Follow up : Consent of the PatientI ------------------------------------------------------------------- hereby willingly agree toparticipate in the clinical trial on Ageing process. I affirm that there has been nocompulsion or monitory inducement in my agreeing to be patient for this project,which I do on my free will. I am convinced that it is for benefit of science & mankind.I have been told about the risks involved. Signature of the Patient.
  • 116. V1. PRADHANA VEDANA: kalaprakarsha2. ANUBANDHI VEDANA: kalaprakarsha3. ADYATANA VYADHI VRITANTA :4. POORVA VYADHI VRITANTA :5. KULAJ VRITANTA :6. VYAKTIKA VRITANTA : i. Ahara : ii. Vihar : iii. Nidra : iv. Vyasana : v. Vyayama : vi.Rajasambandhiitihas:
  • 117. VI7. SAMANYA PAREEKSHA : 1) Weight : 4) Temperature : 2) Height : 5) Pulse : 3) Blood pressure : 6) Respiration rate :8. ASTHAVIDHA PAREEKSHA : 1) Nadi : 5) Shabda : 2) Mutra : 6) Sparsha : 3) Mala : 7) Drik: 4) Jihva : 8) Akriti :9. DASHAVIDHA PAREEKSHA : 1) Prakrutitaha : 6) Samhanan : 2) Vikrutitaha : 7) Satmyataha : 3) Sarataha : 8) Aharshakti : 4) Satvataha : 9) Vyayama shakti : 5) Pramanata : 10) Vaya :10. KOSTHA : a) Mrudu b) Madhyama c) Krura11. AGNI : a) Manda b) Visham c) Teekshna12. SROTAS PAREEKSHA :13. SYSTEMIC EXAMINATION:
  • 118. VII 14. INVESTIGATIONS: Laboratory: Others : 15. NIDANA PANCHAK: 1) Hetu : 2) Poorva Roopa : 3) Roopa : 4) Upashaya / Anupashaya : 5) Samprapti16. VYADHI VINISCHAYA : 17. CHIKITSA KRAMA : GROUP A B DRUG AMALAKI CHOORN ASHWAGANDHA CHOOORNA DOSE 5 GRAM TWICE/DAY 5 GRAM TWICE/DAY ANUPAN Sukhoshana Jala Sukhoshana JalaDURATION 60 DAYS 60 DAYS P.T.F.U. 30TH DAY 30TH DAY18. PATHYA/APATHYA :
  • 119. VIIIParameters for Assessment:1) Subjective ParametersS. No Subjective Parameter B. T. A. T. P.T.F.U. 1. AGNIMANDYA (LOSS OF APPETITE) 2. MALABADDHTA (CONSTIPATION) 3. INDRIYA KSHAYA (PERIPHERAL NEUROPATHY) 4. NIDRA NASHA (INSOMNIA) 5. BALA KSHAYA (LOSS OF STRENGTH) 6. GRAHANA KSHAYA (LOSS OF GRASPING POWER) 7. SHWASA (EXERTIONAL DYSPNOEA) 8. SARVAKRIYA ASWASAMARTH (RESTRICTION OF MOVEMENTS)2) Objective Parameters S. No Objective Parameter B.T. A .T. P.T.F.U. 1. BLOOD PRESSURE 2. WEIGHT3) Observational parameters :S. No Objective Parameter B .T. A .T. 1. HEAMOGLOBIN 2. VISUAL ACUITY 1. Right Eye 2. Left EyeSide effects if any:Signature of Candidate Signature of Staff
  • 120. GROUP A Amalaki A.M. M.B. REG. NO. NAME AGE SEX RELIGION OCCUPATION STATUS FOOD HABIT PRAKRUTI B.T. A.T. F.U. B.T. A.T. 6466 Abdul Karim Dargha 69 M M AG P M KP 2 1 1 2 1 6346 Lal saab Kasim 62 M M AG P M VK 2 2 2 2 1 6483 D.S Tiwari 65 M H B M V PV 2 1 1 1 1 6518 Salim Sekh 61 M M AG P M KV 2 1 1 2 1 6624 Kamla Patten Shetty 64 F H HW M V VP 2 1 1 2 1 6625 Adiyappa Siddppa Haltdi 66 M H AG P V PV 2 1 1 2 1 6640 Manappa Kari 62 M M AG P V KP 2 2 2 2 1 6647 Shardha Pawar 63 F H AG M M PK 2 1 1 1 1 6683 Mallawa Pujari 61 M H AG P V VP 3 2 3 2 2 6784 Meerabai Rajput 64 F H HW P M PK 3 2 2 2 2 6787 Yellona Gotte 61 F H HW P V KP 2 1 2 2 1 6792 Siddramappa 65 M H AG P V VP 1 1 1 2 1 6814 Nandabai Chavan 65 F H HW M V VK 2 1 1 2 2 7363 Suresh Biradar 69 M H RL P V KP 2 1 1 2 1 7440 Jayanath Biradar 70 M H RL M V VP 1 1 2 2 1GROUP B Ashwagandha A.M. M.B. REG. NO. NAME AGE SEX RELIGION OCCUPATION STATUS FOOD HABIT PRAKRUTI B.T. A.T. F.U. B.T. A.T. 6267 Gangabai Nikam 61 F H HW M V VK 2 2 2 2 2 6464 Kaweri Bai Bhutaden 68 F H HW P V VK 2 1 1 1 1 6465 Satirava Hattalli 63 F H HW M M KV 2 2 2 3 2 6475 Lal Saab Mudnal 69 M M RL P M VK 2 1 1 2 2 6519 Mahadevappa 61 M H RL M M PV 2 2 2 2 2 6611 Lalita Pandre 68 F M HW M M VP 2 1 1 2 2 6612 Hussain Saab 68 M H B M V VP 2 2 2 2 1 6613 Mahaveer Pandre 63 M H B P V PK 2 2 2 2 1 6631 Mallikarjuna Tallikoti 69 M H AG M V VP 2 2 2 2 1 6637 Rajiv Pattenshetty 66 M H RL P M KP 3 2 2 3 2 6716 Anil Kabade 66 M H RL P V VP 2 1 2 1 1 6734 Tukaram Tabale 61 M H AG P V PV 2 1 1 2 2 6795 Shashikant Pujari 66 M H AG M V KP 2 2 2 3 2 6815 Paravati Chavan 62 F H HW P V PK 2 1 1 2 2 7166 Yamanappa Shetty 62 M H RL; P V VP 2 1 2 2 1
  • 121. I.K. N.N. B.K. G.K. S.W. S.A. BLOOD PR SYSTOLICF.U. B.T. A.T F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. 1 3 2 2 3 2 2 2 2 2 2 2 2 3 2 2 2 2 2 132 130 134 2 1 2 106 96 1 3 2 2 2 2 2 2 2 2 2 2 2 3 3 3 2 1 1 144 140 140 3 2 2 108 100 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 128 130 126 1 1 1 98 96 2 2 1 1 2 1 2 2 2 2 2 2 2 2 2 2 2 2 2 156 150 150 4 3 3 110 110 1 2 2 2 3 2 2 2 1 2 2 2 2 2 1 1 2 2 2 134 136 134 2 2 2 90 90 1 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 2 2 2 128 120 126 1 1 1 100 98 2 2 2 2 2 1 2 2 2 2 3 3 3 2 2 2 2 2 2 130 130 140 1 1 2 108 110 1 2 1 2 3 2 2 2 2 2 2 2 2 2 1 1 2 1 2 146 140 148 3 2 3 108 98 2 1 1 1 2 2 2 2 1 1 2 2 2 2 2 2 2 2 2 154 150 150 4 3 3 110 108 2 2 2 2 2 1 2 2 2 2 2 2 2 2 2 2 2 1 1 150 144 146 3 3 3 106 9 1 1 1 1 2 2 2 2 2 2 2 1 2 2 2 2 2 2 2 148 148 144 3 3 3 98 100 1 2 2 2 3 2 3 2 2 2 3 2 2 2 2 2 2 2 2 140 140 146 2 2 3 98 98 2 2 2 2 2 2 2 2 2 2 2 1 1 2 1 2 2 2 2 136 128 130 2 1 1 100 100 2 3 2 3 2 1 2 2 2 2 2 2 2 3 2 3 3 3 3 150 144 140 3 3 2 100 98 1 2 2 2 1 1 1 2 1 1 2 2 2 3 3 3 2 2 2 160 154 156 4 4 4 100 96 I.K. N.N. B.K. G.K. S.W. S.A. BLOOD PR SYSTOLIC DIASTF.U. B.T. A.T F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. 2 2 1 1 2 1 1 2 1 1 2 1 1 3 2 2 3 2 2 130 120 124 1 1 1 90 88 1 1 1 1 2 2 2 2 2 2 3 2 3 3 3 3 2 2 2 130 130 136 1 1 2 100 98 2 2 1 1 2 1 1 2 1 1 2 1 1 2 1 2 2 2 2 130 124 126 1 1 1 104 94 2 2 1 1 2 1 1 2 1 2 2 1 1 3 2 2 3 2 2 140 130 130 2 1 1 96 90 2 2 1 1 2 1 2 2 1 1 2 2 2 2 1 1 2 1 2 150 136 140 3 2 2 94 90 2 3 1 1 1 1 1 2 2 2 3 1 2 2 2 2 2 2 2 146 130 130 3 1 1 100 98 2 3 1 2 3 1 2 2 1 2 3 1 2 3 2 2 3 2 2 140 122 130 2 1 1 100 98 1 2 1 1 3 2 2 2 2 2 3 1 1 2 2 2 2 1 1 140 124 128 2 1 1 98 90 2 3 1 1 2 1 1 2 1 1 3 1 2 3 2 2 2 1 2 130 120 120 1 1 1 88 90 2 2 1 2 3 2 2 2 1 1 2 1 1 3 2 2 2 1 2 144 124 130 3 1 1 100 88 2 2 1 1 2 1 1 2 1 1 3 2 2 2 1 2 2 1 1 120 120 126 1 1 1 106 86 2 2 2 2 2 1 2 2 1 2 2 1 1 2 1 1 2 1 1 150 128 130 3 1 1 100 86 3 2 1 2 2 1 2 2 1 1 2 1 1 2 2 2 2 1 1 140 120 126 2 1 1 98 90 2 2 1 1 1 1 1 2 2 2 2 1 1 2 1 1 2 1 2 136 130 130 2 1 1 90 84 1 2 2 2 2 1 2 2 1 2 2 1 1 2 1 2 2 1 1 120 120 122 1 1 1 106 90
  • 122. RESSURE WEIGHT HEAMOGLOBIN DIASTOLIC RT. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. B.T. A.T. B.T. 94 3 2 2 48 48.5 48 6 6 6 11 11.8 3 3 IOL 100 3 2 2 49 49 49 6 6 6 12.2 14.2 2 1 IOL 100 2 2 2 50 50.5 51 5 5 5 10.6 10 3 3 618 106 3 3 3 60 62 61 3 3 3 9 9.2 4 4 618 88 1 1 1 46 46.5 46 6 6 6 10.8 11 3 3 624 102 2 2 3 52 52 52 5 5 5 11.6 11.8 3 3 IOL 106 3 3 3 65 65 65.5 2 2 2 9.4 9.6 4 4 624 100 3 2 2 66 66.5 67 2 2 2 10.4 10.4 3 3 618 102 3 3 3 43 44 43 7 7 7 10.2 10.2 3 3 624 98 3 2 2 55.5 57 57 4 4 4 11.2 11 3 3 636 96 2 2 2 41 41 41 7 7 7 12.8 12.6 2 2 624 100 2 2 2 55 55.5 55 4 4 4 10.4 10.6 3 3 IOL 96 2 2 2 58 58 58 4 4 4 10 10.2 3 3 FC4f 98 2 2 2 59 59 59 4 4 4 12 11.8 2 3 IOL 100 2 2 2 45 44 44 6 7 7 14.2 14.2 1 1 IOLRESSURE WEIGHT(Kg.) HEAMOGLOBINTOLIC RT. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. F.U. B.T. A.T. B.T. A.T. B.T. 90 1 1 1 45 46 46 6 6 6 12.4 14 2 1 636 100 2 2 2 41.5 43 43 7 7 7 10.8 11.8 3 3 IOL 100 3 2 2 46 48 48 6 6 6 11.2 12.8 3 2 624 94 2 1 2 48 50 49 6 5 6 13.8 14 2 1 618 88 2 1 1 41 42 42 7 7 7 10 10.4 3 3 618 96 2 2 2 52 53 53 5 5 7 11.6 12 3 2 IOL 98 2 2 2 54 55 55 5 4 4 12.8 14 2 1 FC4f 90 2 1 1 50 52 52 5 5 5 11 12 3 2 624 98 1 1 2 46 46.5 47 6 6 6 12 12.8 2 2 IOL 88 2 1 1 58.5 60.5 60 4 3 3 11 11.8 3 3 FC5f 92 3 1 2 63 63 63 3 3 3 10.4 11.2 3 3 IOL 88 2 1 1 60 61 61 3 3 3 11.2 12.2 3 2 IOL 90 2 1 1 55.5 56 56 4 4 3 13.8 13.8 2 2 624 80 1 1 1 66.5 67 66.5 2 2 2 10.4 10.2 3 3 618 94 3 1 2 53 54 54 5 5 5 12.4 13 2 2 636
  • 123. VISUAL ACUITY VISUAL ACUITY GRADINGEYE LT. EYE RT. EYE LT. EYE A.T. B.T. A.T. B.T. A.T. B.T. A.T. IOL IOL IOL 0 0 0 0 IOL IOL IOL 0 0 0 0 618 624 624 4 4 5 5 618 624 618 4 4 5 4 618 624 624 5 4 5 5 IOL IOL IOL 0 0 0 0 624 624 618 5 5 5 4 618 618 618 4 4 4 4 618 618 618 5 4 4 4 624 IOL IOL 6 5 0 0 618 624 624 5 4 5 5 IOL IOL IOL 0 0 0 0 FC5f 636 624 9 8 6 5 IOL 624 624 0 0 5 5 IOL 636 624 0 0 6 5 VISUAL ACUITY VISUAL ACUITY GRADINGEYE LT. EYE RT. EYE LT. EYE A.T. B.T. A.T. B.T. A.T. B.T. A.T. 636 636 636 6 6 6 6 IOL 624 624 0 0 5 5 624 624 624 5 5 5 5 618 618 618 4 4 4 4 618 618 618 4 4 4 4 IOL IOL IOL 0 0 0 0 FC4f FC4f FC4f 9 9 9 9 624 FC5f FC5f 5 5 8 8 IOL FC3f FC4f 0 0 10 9 FC5f 624 618 8 8 5 4 IOL 624 624 0 0 5 5 IOL IOL IOL 0 0 0 0 618 FC4f FC4f 5 4 9 9 618 624 624 4 4 5 5 624 FC5f FC4f 6 5 8 9