Jara sandivata-ss-mys
Upcoming SlideShare
Loading in...5
×
 

Jara sandivata-ss-mys

on

  • 1,593 views

KALYANI ASHOK BHUSANE, A STUDY ON JARA W.S.R. TO ROLE OF MATRABASTI IN JANUSANDHIGATVATA, DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA, GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE. 2010

KALYANI ASHOK BHUSANE, A STUDY ON JARA W.S.R. TO ROLE OF MATRABASTI IN JANUSANDHIGATVATA, DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA, GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE. 2010

Statistics

Views

Total Views
1,593
Views on SlideShare
1,593
Embed Views
0

Actions

Likes
1
Downloads
18
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Jara sandivata-ss-mys Jara sandivata-ss-mys Document Transcript

  • I  “A STUDY ON JARA W.S.R. TO ROLE OFMATRABASTI IN JANUSANDHIGATVATA”ByDR.KALYANI ASHOK BHUSANE B.A.M.SDissertation submitted to theRajiv Gandhi University of Health Sciences,Karnataka, Bangalore.In the partial fulfilment of the requirements for the degree ofDOCTOR OF MEDICINE (AYURVEDA)InAYURVEDA SIDDHANTAUnder The Guidance ofDr. N. ANJANEYA MURTHY M.D. (Ayu)Professor,Department of Post-Graduate Studies in Ayurveda Siddhanta,G.A.M.C., Mysore.Co-GuideDr. ANAND KATTI M.D. (Ayu)Lecturer,Department of Post-Graduate Studies in Ayurveda Siddhanta,G.A.M.C., Mysore.Mysore – 570021DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDASIDDHANTA,GOVERNMENT AYURVEDA MEDICAL COLLEGE,MYSORE.2010
  • II  
  • III  
  • IV  
  • V  
  • VI  
  • VII  ACKNOWLEDGEMENTThere is hardly any task which is more pleasant to acknowledge, my gratitude to allthose who have helped/blessed me for successful completion of this dissertation.I bow my head to my adorable Late Grandmother Smt. Ratnabai Bhusane andGrandfather Shivadas Bhusane whose belief and blessing are the constant drivingforce behind me.I owe my deepest sense of gratitude to my Honourable guide, former HOD, Dr. N.Anjaneya Murthy, M.D (Ayu), Joint Director of AYUSH, Govt. of Karnataka, forhis inspiration, unstinted support, continuous scrutiny, guidance and immense help atevery stage of this study.I express my gratitude to my co-guide Dr.Anand Katti, Lecturer, Department of PGstudies in Ayurveda Siddhanta, GAMC, Mysore, for his immense support, time totime guidance and encouragement during the course of this work.I express my heartfelt sense of gratitude to Dr.Naseema Akhtar, Professor and HOD,Department of PG Studies in Ayurveda Siddhanta, GAMC, Mysore, for her constantguidance, continuous supervision and help at every stage of this study.I express my heartfelt sense of gratitude to Late Dr. Shakunthala G. N. Professorand former HOD, Department of PG Studies in Ayurveda Siddhanta, GAMC,Mysore, for her everlasting support and inspiration.I am also thankful to Dr. Ashok D. Satpute, Principal, GAMC, Mysore, for hisguidance and support that he had provided during the period of my study.I feel short of any language to express my sincere feelings to my teacher Dr. MalhariSirdeshpande, for his incessant guidance and immense support, without whom Icould not have joined Post graduation course.
  • VIII  I am grateful to. T. D. Ksheersagar, Dr. V. Rajendra, Dr.Shreevatsa andDr.V.A.Chate for their special attention, continuous support and suggestions whichhave very crucial role in completion of this study.I would like to place on record my deep sense of gratitude to my beloved teachers,Dr. Chandramouli, Dr. Shantaram, Dr. Gopinath, Dr. R. C. Mythreyi, Dr.AnantDesai, Dr. K.Venkat Shivudu, Dr.Alka Jayavanth Kumar and Dr. Adarsh fortheir inspiration during my P.G. studies.I am also thankful to all other teachers of G.A.M.C. Mysore, for their support andsuggestions.Lexicons have failed to coin befitting words to express my gratitude towards myhighly esteemed parents Smt. Mahadevi Bhusane and Shri. Ashok Bhusane whoseblessings are the driving force behind all my progress, achievements and success. Thewarm care and silent love of my sisters always makes my heart full with gratitude.I am unable to forget eminent physician Dr. Basavraj Kolur, Dr. Atul Kulkarni, Dr.Zawar, Dr. Dama, Dr. P.T. Kulkarni, Dr. K.D.Shendge for their constantencouragement to reach my goal in life.I convey my special thanks to my UG lecturers Dr. R.V.Shettar, Dr.Yashoda, Dr.Vedamurthi, Dr.Shankargouda, Dr.Panda, Dr. Santosh Yedahalli, Dr. Santoshji, Dr.Joshi, for their encouragement and guidance.I express my deep sense of gratitude to Vidwan Shri Gangadhara Bhat, and VidwanShree Hegade for their kind support in understanding grammatical aspects ofAyurvedic literature in this course of study.I convey my thanks to my seniors Dr.Yogesh, Dr.Savita Shenoy, Dr.Kedar SharmaDr.H.D.Vijayalakshmi, Dr.Soubhagya, Dr. Aparna, Dr. Annapoorni, Dr. Rajesh, Dr.Pankaj, for their continuous help, encouragement and suggestions.
  • IX  I would like to thank all my colleagues Dr. Geetha.P, Dr.Ranjith kumar Shetty,Dr.Ramesh Kumar, Dr.Kavitha, Dr. Vyasraj, Dr. Ranjani, Dr.Shayan, Dr.Kiran,Dr.Parveen, Dr.Sameena, and Dr.Pallavi for their timely support during my course ofstudy.I thank Dr. Lancy D.Souza for helping in statistical analysis and interpretation.I am overwhelmingly thankful Mallaya and Natraja Uncle for their love, kindness andcooperation during my stay in Mysore.It is beyond my vocabulary to express my feelings towards my juniors Dr.Athika,Dr.Geetha, Dr.Pallavi, Dr.Aravind, Dr.Rekha, Dr.Prita, Dr.Aditya, Dr.Mahesh,Dr.Soumya, Dr.Shubha, Dr.Shridhar, Dr.Arun, Dr.Atul, Dr.Arahanth, Dr.Swapna,Dr.Divya with whom I enjoyed the cordial relationship.“Friends are the gift you give yourself” this proverb proved by love and affectionrendered by my ever dearest friends Dr.Mahantesh, Dr. Sangamesh, Dr. Nitin, Dr.Nitesh, Dr. Shivaraj, with their cooperation during this work.I convey my heartfelt thanks to Manager, M/s SDM Ayurveda Pharmacy Udupi whohelped me in procuring drugs for my dissertation.I thank Mr.Mahesh C, Maneesh printers Mysore, for bringing this work in adocumented form.I extend my regards to our dept attainder Annaiachar and librarians Smt. Varalakshmi,Mr. Somasundar, and Mr. Raju GAMC, Mysore.“To err is Human” - certain names who could be directly or indirectly helpful in thiswork, might have missed unintentionally, thanks are due to all of them.Finally it is benediction of God Shiva that I have reached to this stage in my life.Date:Place: Mysore Dr. Kalyani Ashok Bhusane
  • X  LIST OF ABBREVIATIONS A. K - Amara KoshaA.H - Astanga HridayaA.S - Astanga SangrahaA.T - After TreatmentA.V - Atharva VedaB.P - Bhava PrakashaB.R - Bhaishajya RatnavaliB.S - Bhela SamhitaB.T - Before TreatmentC.D - Chakra DattaC.S - Charaka SamhitaChi. - Chikitsa sthanaD.G.V - Dravya Guna VijnanaH.S - Hareeta SamhitaHS - Highly SignificantKS - Kashyapa SamhitaM.N - Madhava NidanaMa - Madhyama khandaNi - Nidana sthanaNS - Not SignificantH.P.I.M - Harrison’s Principles of Internal MedicinePu - PurvakhandaRRS - Rasa Ratna SamucchayaS.E.D - Sanskrit English Dictionary – M.M.WilliamsS.K.D - Shabda Kalpa DrumaS.S - Sushruta SamhitaSSM - Shabda Stoma MahanidhiSh - Shareera sthanaSha. S - Sharangadhara SamhitaSS - Statistically SignificantSu - Sutra sthana
  • XI  U - Uttara tantraUt - UttarardhaVch - VachaspatyamY.R - Yoga RatnakaraSi Ni - Siddantha Nidana
  • XII  ABSTRACTBackground of the StudyThe urge to live, the fear of death, the desire of youth, the distaste for old age and thequest for Rejuvenation have always interested mankind from antiquity to moderntimes. Old age followed by death has been so accepted as a fact of life. Geriatric isemerging as a challenging specialty, because of ever growing population of Agedpeople all over the world including India. The problem before the scientists, therefore,is how to keep the old people physically fit and how to make them use to society.Ayurveda system of Medicine offers an excellent line of Management for these“Jaravikars” That was the reason why “JARA- CHIKITSA” has been mentioned asone independent anga in Ashtanga Ayurveda. It implies delaying the process ofageing and managing the problems of old age.Janusandhigatavata (Knee-Osteoarthritis) is by far the commonest form of arthritis. Itshows a strong association with ageing and is major cause of pain and disability in theelderly. Keeping this in mind present study was undertaken as to analyze the conceptof Jara and to observe the effect of Ashwagandha Ghrita Matrabasti inJanusandhigatavata.MethodA Single Group Clinical Study.Intervention30 patients of Janusandhigatavata belonging to 60-75 years of age group wereselected from OPD and IPD GAMCH Mysore. They were assigned into single group.60 ml of Ashwagandha Ghrita Matrabasti was administered for 9 days and followedby follow up period of 18 days thereafter. The drug was administered after the
  • XIII  morning food. The different parameters of the study were recorded before treatment(0 day), after treatment (10thday) and after the follow-up (27thday).Then they were analyzed by means of Chi square test, repeated measure ANOVA andContingency Coefficient Descriptive Statistics.RESULTSStatistics showed highly significant improvement in 3 Sections of WOMAC Scale i.e.pain, stiffness and level of difficulty in performing work. In overall assessment mostpatients had mild and moderate improvement.Interpretation and ConclusionAfter treatment good result was observed, this was probably because thepharmacological actions of Ashwagandha Ghrita i.e. analgesic, anti-inflammatory,antioxidant, immunomodulatory, and rejuvenating properties.Keywords: - Jara Geriatrics Ageing Rasayana Janusandhigatavata Matrabasti          
  • XIV  CONTENTSSL.NO. Particular PageNo.1 Introduction 12 Objectives 33 Concept of Jara 44 Geriatrics 415 Janusandhigatavata 726 Knee-Osteoarthritis 847 Matrabasti 1038Review of literatureDrug Review 1109 Materials and Methods 11110 Observations and Results 12011 Discussion 14312 Conclusion 20613 Summary 20714 Bibliography and References 20915 Annexure I-XIV
  • XV  LIST OF TABLESTable No. Name of the Table Page No.1 Avastas of vayas 72 Jara Lakshanas 18-193 Decade wise ageing process 234 Dincharya and its benefits 265 Indications and contraindications in old age 37-386 Rasayana yogas indicated in old age 39-407 Age related changes 66-678 Laboratory values in old age 689 Functional changes in old age 69-7010 Comparison of specific activities of enzymesin tissues of adult and old mammals70-7111 Roopa of Janusandhigatvata according tovarious classical texts7812 Sapeksha Nidana of Janusandhigatavata 80-8113 Chikitsa according to Different Acharyas 8214 Shamanoushadhi in Sandhigata Vata 8215 Pathya-Apathya of Sandhigatvata 8316 Movements at the knee joint 8917 Signs and symptoms of O A 9518 Differential diagnosis of Osteo arthritis 98-9919 Indications of Matra Basti 10520 Drug review 11021 Age group incidence. 12022 Incidence of religion 12023 Sex incidence. 12024 Incidence of occupation. 12125 Incidence of education. 12126 Prevalence of diet 12127 Prevalence of Chronicity 12228 Prevalence of Socio - economic status 122
  • XVI  29 Incidence of locality of patients. 12230 Incidence of Deha Prakruti 12331 Incidence of Sara 12332 Incidence of Samhanana 12333 Incidence of Satva 12434 Incidence of Bala 12435 Pain while walking on flat surface 12436 Pain while going up and down stairs 12537 Pain at night while in bed 12538 Pain at rest (sitting or lying) 12639 Pain on weight bearing 12640 Morning Stiffness 12741 Stiffness occurring during the day 12742 Difficulty in Ascending stairs 12843 Difficulty in Descending stairs 12844 Difficulty in Rising from sitting 12945 Difficulty in Standing 12946 Difficulty in Sitting 13047 Difficulty in Bending to the floor 13048 Difficulty in Walking on flat surface 13149 Difficulty in Getting in / out of bed 13150 Difficulty in Getting in / out of toilet 13251 Difficulty in Getting in / out of bath 13252 Difficulty in Light domestic duties 13353 Pain section 13354 Stiffness section 13455 Physical activities section 13456 Overall results in WOMAC Scale 13557 Results in Flexion-Right knee, 13558 Results in Flexion of Left knee 13659 Overall improvement in patients 13660 Theories of ageing (Ayurvedic andcontemporary)152
  • XVII  LIST OF ILLUSTRATIONSIllustrationno.Name of the illustrations PageNo.1 Pain at walking on flat surface 1372 Pain at going up and down stairs 1373 Pain At night while in bed 1374 Pain at Rest (sitting or lying) 1385 Morning Stiffness 1386 Ascending stairs 1387 Result in Rising from sitting 1398 Result in Sitting 1399 Result in Bending to the floor 13910 Result in result in walking on flat surface 14011 Result in Getting in / out of toilet 14012 Result in getting in / out of bath 14013 Result in light domestic duties 14114 Overall results in Pain section of WOMAC Scale 14115 Results in Stiffness section of WOMAC Scale 14116 Overall results in Physical activities section ofWOMAC Scale14217 Overall results in WOMAC Scale 14218 Overall result 142
  • XVIII  LI ST OF FLOW CHARTTableNo.Name of the flow chart Page No.1 Vata and Swabhava 1542 Mode of action of Rasayana 1763 Samprapti of Janusandhigata Vata 181LIST OF FIGURESTableNo.Name of the figure Page No.1 Percentage of functions at 70-80 years of age100% at 20 years642 Features and consequences of normal aging 65
  • KEY WORDS OF MASTER CHARTRLG-Religion- 1 -Hindu, 2- MuslimOCN-Occupation- 1 -House wife, 2- Labour, 3 -BusinessEDU-Education- 1- illiterate, 2- Primary School, 3- Middle School, 4- GraduateCHR-ChronicityS.E.S-Socioeconomic status- 1 -Poor, 2- Middle class, 3 -RichHBT-Habitat- 1 -Rural, 2 -UrbanPKR-Prakruti- 1 -Vata, 2- Vata kapha, 3 -Vatapitta, 4 -Pitta kaphaSRA-Sara- 1 -Pravara, 2 -Madhyama, 3 -AvaraSMH-Samhanana- 1 -Pravara, 2 -Madhyama, 3 -AvaraSTV-Satva- 1 -Pravara, 2- Madhyama, 3 -AvaraP1-Pain: walking on flat surfaceP2-Pain: going up and down stairsP3-Pain: at night while in bedP4-Pain: rest (sitting or lying)P5-Pain: standing upright (weight bearing)S1-Morning stiffnessS2-Stiffness occurring during the dayPA1-Ascending stairsPA2-Descending stairsPA3-Rising from sittingPA4-StandingPA5-SittingPA6-Bending to the floorPA7-Walking on flat surfacePA8-Getting in / out of bedPA9-Getting in / out of toiletPA10-Getting in / out of bathPA11-Light domestic duties
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   1  INTRODUCTION“The goal of life is to die young as late as possible”.- Asle montegue.The global effort today is not only to heal, but to protect and delay the ageing. Inother words, ageing period should be as healthy as possible and reasonablymeaningful confirming to the W.H.O’s slogan,“It is not sufficient to add years to life but the more important objective is to add lifeto years.”Though growing old is a part of life cycle, a strong group of above 60 years ofage is building up to cause further challenge to the medical world. In India, the elderlypopulation has grown manifold while only 19 million people were above 60 years in1947, today the figure has risen to nearly 80 million; the figure is expected to doublein next 25 years1.Geriatrics is a vast branch of medicine dealing exclusively with the problems ofageing and the diseases of elderly like, osteoarthritis, dementia, Parkinson’s disease,C.O.P.D, Insomnia etc. The World Health Organisation (WHO) very appropriatelydeclared the calendar year 1999 as the year of Elderly People – Senior Citizens, tofocus on the growing problems of the ageing people. This offers an opportunity togather the scattered matter spread over many Ayurvedic classics and other sources ofinformation.Ayurveda the science of life has observed ageing as a graceful phenomenon. Oldage and its health problems were of great concern even for Acharyas during Vedicperiod. That was the reason why JARA- CHIKITSA has been mentioned as oneindependent anga in Ashtanga Ayurveda.It implies delaying the process of ageing andmanageing the problems of old age.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   2  Jara is Swabhavika vyadhi which is natural, unavoidable, and palliable. In fact notreatment can prevent old age or changes occuring due to age, but the process can bedelayed. The detailed study of JARA in the light of recent developments in the fieldof geriatrics is very much essential to understand, analyse and revalidate theprinciples related to Jara.In Vrudhas Vata dosha is in a dominant state and Rasadi dhatus are in a deprivedstate. This potent combination is responsible for the aged being vulnerable to manydiseases. Among them, Janusandhigatavata a vata vyadhi which is equated to Knee-Osteoarthritis stands top in the list of old age diseases. 80% of old age people haveradiological evidence of Osteoarthritis, though 25-30% is symptomatic. Knee-Osteoarthritis is a major cause of disability, limiting activity and impaired quality oflife especially among elderly, the disease is more crippling in its advanced stage. It isranked one among few diseases branded by WHO as “Global Disease Burden”.All the Rasayana drugs have properties like Medhya, Balya, Dhatupushtikara,Brumhaniya, Jivaniya, and Agnivardhaka etc. and also have proven pharmacologicalactions, such as: Adaptogens, Antioxidant, Immunostimulants, Antistress, Nootropics,Anabolics, Tonics and other geriatric properties. Thus, Rasayana formulationsdescribed in the classics have very good composition with maximum properties ondemand.Matrabasti is a very unique therapeutic procedure because of its preventive,health promotive, rejuvenative properties. It is applicable in all Vatavyadhis. Matrabasti is most indicated procedure in Vrudhas due to property of Balya, Vatahara andAgni sandhukshana.In this background the present study titled “A Study on Jara w.s.r. to Role ofMatrabasti in Janusandhigatvata (Knee Osteoarthritis)” is undertaken.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   3  OBJECTIVES OF THE STUDYThe study includes conceptual and clinical part.The conceptual part deals with the following objectives To systematically compile and analyse Jara. To study Aetiopathogenesis of Janusandhigatavata in elderly, with Ayurvedic aswell as Modern focus.The clinical part deals with the following objective, To observe the effect of Ashwagandha Ghrita Matrabasti in Janusandhigatavata.(Knee Osteoarthritis).
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   4  CONCEPT OF JARADerivation:The word “eÉUÉ” is derived from the root “eÉÚ” and suffix “AÇaÉç”, which means2,1. “eÉUÉ uÉrÉÉåWûÉlÉÉæ “- Loss of age2.2. “zÉæÍjÉsrÉ AmÉÉSMüÉuÉxjÉÉ uÉrÉÉåpÉåSå” 3The stage of life when the body tissues begin to attain flaccidity.3. “uÉrÉMÚüiÉç zsÉjÉqÉÉÇxÉɱ AuÉxjÉÉ ÌuÉzÉåwÉ “4Jara means loosening of muscle and other tissues under the influence of ageing.DefinitionThe definition of the word ‘Jara’ according to different classical literature are listedbelow,1. “mÉÍsÉiÉÇ eÉUxÉÉÇ zÉÉãYsrÉÇ MåüzÉÉSÉã ÌuÉx§ÉxÉÉ eÉUÉ”5Jara means whitening of hairs, beard and frailty.2. “eÉÏUrÉliÉÏ AlÉrÉÉå AÇaÉÉlÉÏ CÌiÉ eÉUÉ”6Jara means of degeneration of bodily organ.3. Jara is a swabhavabala pravrutta vyadhi that occurs due to kalasya parinaama7.4. Jara is one of the naturally occurring disease (swabhavika vyadhi) of life after 70years, which is similar to a deteriorating old house where there is impropernourishment occuring due to flaccid state of body tissues8.5. Vrudha as the one who has mandabudhi but his pravrutti is continuous till death9.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   5  6. Jara is the stage of life which appears before death and which is karmadheya andyuganiyat10.7. Dalhana opines that “Jara is defined as a vata dominant state occuring inspite ofprevention and which is upachararahita (untreatable), yapya (palliable), kalakritavyadhi (timely occurring) and requiring supernatural rejuvenation (atyantikarasayana) to reverse agony”.118. Jara means Pashcima Vaya, i.e. third stage of life.129. Bhavamishra defines Jara as a progressive deteriorating stage of life,characterized by decline of dhatu, indriyas, bala vali, palitya, khalitya, karmaakshama, kasa and shwasa.13Synonyms of Jara14Amarkosha mentioned the synonyms of Jara as,      Visramsa     Degradation of the shareera and Mana.  Pravaya       Elapsing of the years after the Youvana     Sthavir          Incapacity  or  the  impairments  of  the  movements  of  the  Aged persons.  Vrudha          Matured person.  Jeen               Loss of age.  Jeerna &      Increased degenerative process.  Jaran    
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   6    Dictionary meaning of Jara15 To make old or decrepit , to cause to grow old , to grow old , become decrepit , decay, wear out , be consumed , break up , perish to be disclosed or digested.  Words related to Jara16  1. Jaraavastha:-Decrepitude, state of old age,2. Jaraatura:-Decrepit from age,3. Jarajeerna:-General debility consequent on old age,4. Jarabheeru:-Afraid of old age,5. Jaradharma:-laws of old age or decay,6. Jaraparinana:-Bent down with age,7. Jaralakshana:-Age sign- grey hair etc.8. Jaramrutyu:-Dying from old age.VAYASTo understand the concept of Jara the knowledge of Vayas and its avasthas is essentialbecause all classical literature of Ayurveda defined Jara on the basis of Vayas, Charaka Samhita defines the Vayas as a factor dependent on Kala PramanaVishesa i.e., quantum of time duration17 Vaya is the time bound changes occurring in the body.(A.D. on A.H.Sha.3/10)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   7   “uÉwÉïzÉiÉÇ ZÉsuÉÉrÉÑwÉ: mÉëqÉÉhÉqÉÎxqÉlÉç MüÉsÉå:” | cÉ.zÉÉ. 6/29In the present Era (kaliyuga), the human life span has been considered as 100 yrs.AVASTHAS OF VAYASAyurvedic texts divide human life span into three major categories - Balya, Madhyaand Vruddha based on chronological age. There are some difference of opinionsregarding these avasthas in different Samhita, which are tabulated below,Table 1. Showing Avasthas of VayasAVASTHAS OF VAYASSAMHITASBalya Yuva Madhyama Vruddha AyupramanaCharaka Samhita181-30yrs.- 30-60 yrs. 60-100yrs.100 yrs.Sushruta Samhita191-16yrs.- 16-70 yrs. 70-100yrs.100 yrs.Kasyapa Samhita201-16yrs.16-34yrs.34-70 yrs. 70-100yrs.100 yrs.AstangaSamgraha211-16yrs.- 16-60 yrs. 60-100yrs.100 yrs.Astanga Hridaya221-16yrs.- 16-70 yrs. 70-100yrs.100 yrs.Bhavaprakasha231-20yrs.- 20-70 yrs. 70-100yrs.100 yrs.Chakrapani241-36yrs.1-25yrs.--36-72 yrs.25-50 yrs.72-120yrs.50-80 yrs.120 yrs.Pravaraayu80 yrs.Madyamaayu
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   8    TYPES OF JARA25Sushruta Samhita classifies the Jara into two types, Kalaja and Akalaja Jara.KALAJA JARAJara coming at the proper age is Kalaja Jara i.e., after 70 years of life. Dalhana opines that, kalaja means “MüÉsÉeÉÉ CÌiÉ rÉå xÉqÉrÉå mÉëÉmiÉÉ pÉuÉÎliÉ |” ie. One which occurs timely.  Hence, appearance of signs and symptoms of ageing at a particular scheduled age is considered as kalaja jara i.e. normal ageing. Acharya Dalhana opines that this types of ageing is inevitable and there are no causative factors that exist to prevent its occurrence,  hence  he  called  it  as  “mÉËUU¤ÉhÉM×üiÉÉÈ”  that  means  it  occurs  even  by following preventive health care measures.  AKALAJA JARADalhana explained that, Akalaja means “AMüÉsÉeÉÉ AxÉqÉrÉå eÉÉiÉÉ” i.e. one which occursuntimely before its prescribed time, Hence appearance of sign and symptoms ofageing prior to schedule age is considered as akalaja Jara. (Premature ageing).Acharya Dalhana opines that this type of ageing is acquired one. Hence he called it is“AmÉËUU¤ÉhÉM×üiÉÉ” that means it occurs by following improper health care measures.Chakrapani considered the occurrence of premature ageing, in persons having featuresof short life span (Avarayu).FACTORS RESPONSIBLE FOR KALAJA JARA
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   9  No  specific  aetiology  of  Kalaja  Jara  has  been  described  as  such  in  any  of  the Ayurvedic classics. But, there are some factors, which can be considered favourable in this regard. Those factors are explained below, 1. Kala:2. Swabhava:3. Vata:4. Shareera Vruddhikara bhava -abhava (Depletion of Growth Factors)5. Sahaja Theory:6. Rasa Shoshana:7. Dhatu asamata:8. Agni asamata:9. Oja Kshaya:1. Kala:MüÉsÉxrÉ mÉËUhÉÉqÉålÉ eÉUÉqÉ×irÉÑÌlÉÍqɨÉeÉÉÈ| cÉ.zÉÉ. 1/11Transformation is the hallmark of time, everything that is living undergoesvarious changes before it is worn out completely. This cycle of changes is known inAyurveda as Parinama which takes place under the constant influence of Kala (thetime factor).The sequential events of Balya, Tarunya, Youvana, Proudha, andVardhakya are all consequential eventualities of Kala.Therefore Ayurveda recognizedKala or Parinama as the potential causative factor of degenerative diseases entities.xÉ cÉæuÉ aÉpÉïÈ MüÉsÉÉliÉUåhÉ oÉÉsÉrÉÑuÉxjÉÌuÉU pÉÉuÉÉlÉç mÉëÉmlÉÉåÌiÉ. || (cÉ.zÉÉ. 3/8).Charaka Samhita mentions that the same foetus after the lapse of definite timebecomes child, young and old. Again Charaka Samhita has clearly mentioned that the
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   10  cause of Jara and Mrtyu is due to Kalasya Parinama. (cÉ.zÉÉ. 1/115) Commenting onthis Gangadhara says that,“rÉÉæuÉlÉÉliÉå MüÉsÉmÉËUhÉÉqÉålÉ eÉUÉ pÉuÉÌiÉ, eÉUÉliÉå MüÉsÉmÉËUhÉÉqÉålÉ qÉ×irÉÑpÉïuÉÌiÉ |”26  i.e.,  as  the  time advances,  puberty  phase  turns  into  adulthood  which  in  turn  ends  in  death  of  an individual. Sushruta Samhita also emphasized the involvement of Kala in the development of an individual or  ageing process. It  explains that because of time  factor,  there will be appearance of secondary sexual characteristics in an individual. This indicates that the childhood has landed up into stage of puberty27.  From  the  foregoing  quotations,  it  is  evident  that  Kala  which  cannot  be stopped  at  any  cost  is  an  important  cause  of  ageing  process.  Thus  it  can  be summarized as, the growth and senescence occurs naturally as time passes. 2. Swabhava:Literally, Swabhava means the ‘inherent property’ or ‘innate property’ or ‘by nature itself’ or ‘natural constitution’.  The nature’s unique process which is invisible can be called as Swabhava. CharakaSamhita in swabhavouparamavada explains that, “there is a causative factor for themanifestation of beings but no causative factor as such exists for their deterioration”.That means the process of deterioration occurs naturally28.Sushruta Samhita also has the same opinion. It mentioned that,  A…ûmÉëirÉ…ûÌlÉuÉ×̨ÉÈ xuÉpÉÉuÉÉSåuÉ eÉÉrÉiÉå || xÉÑ.zÉÉ. 3/36
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   11  The  growth  and  development  of  body  parts  from  the  time  of  conception  till  the death of an individual is a natural phenomenon. xuÉpÉÉuÉoÉsÉmÉëuÉרÉÉ rÉå ¤ÉÑÎimÉmÉÉxÉÉeÉUÉqÉ×irÉÑÌlÉSìÉmÉëpÉ×iÉrÉÈ|| (Su. Su. 24/7)Moreover, Sushruta Samhita adds saying that Jara (old age) is a Swabhavika Vyadhi or Swabhava bala Pravrutta Vyadhi. i.e., Jara occurs by nature itself which cannot be stopped by any intervention. Thus Swabhava can be considered as a responsible factor in the causation of Jara which is invisible and nature’s unique process. 3. Vata:Vata is the most important factor to be considered in old age, obviouslybecause of its natural predominance at that stage of life. Chakrapani, justifying theimportance attached to Vayu clarified; Vayu is the ‘Niyanta’ or that which governsthe unity of the components of Ayu such as Shareera, Indriya, Satva and Atma, Vayuitself may be called as Ayu29. Sushruta Samhita explains that Vata is responsiblefactor for creation, maintenance and destruction of all beings30.In Charaka Samhita Sankhya shareera Adhyaya it is said that, the body ismade up of paramanus which are Atibahu, Atisookshma and Atindriya.Commentingon this Chakrapani opines that the combination of Paramanus are responsible forShareerarambha (growth of the body) and their division for Shareeravinasha(degradation of body tissue)31.Charaka Samhita further opines that this process occurs naturally with the help offunctional unit of vata because the samyoga and viyoga are the functions of vata.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   12  4. Shareera Vriddhikarabhava abhava 32Charaka Samhita mentioned the 4 factors, the presence of which represents thegrowth, where as the absence representing the senescence. (cÉ.zÉÉ. 6/12) Those are asfollows, 1. Kala yoga (time bounded phenomenon)2. Swabhava samsiddhi (Natural factor)3. Ahaar sousthava (diet)4. Avighata (avoiding physical and mental stress)1. Kalayoga (Time bounded phenomenon)Chakrapani says that, upto the age of 17; the youth phase itself is the time boundedfactor (ie. kalayoga) which enables the body to attain growth. Exactly opposite to theabove the body starts deterioration, leading to senility.2. Swabhava Samsiddhi (Natural factor)The invisible (adrustha), nature’s unique process which is responsible factor for bothgrowth and deterioration of the body.3. Ahara sousthava (Diet factor) Diet is the most important factor in controlling the ageing process and even in its onset. Charaka Samhita opines that ahara sousthava /ahara sampat is responsible for the  proper  growth  and  development  of  the  body.  Matra  ahara  is  responsible  for healthy  ageing  (sukhayu)  and  longevity  (Dheergayu).  Amatravat  Ahara  leads  to pathological ageing (dukhayu) and shortens the span of life (alpayu). 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   13  4. Avighata (Avoiding physical and mental stress)        Chakrapani says that for the proper growth and development it is necessary to avoid physical and mental stress.   5. Sahaja TheoryCharaka Samhita opines that - prakriti guna sampat33ie. Constitutional compactness isone of the prime factors required to achieve long life span, which is geneticallydetermined as explained by Chakrapani. Chakrapani adds further saying that thenature (Swabhava) of a particular individual depends upon the invisible factors, whichare genetically carried out by that particular race in which he born. The word“Prakriti” here denotes both the nature of a particular species and the nature of anindividual within that particular species. For example, the onset of ageing processdiffers from one species to another. Similarly, within the species also, the nature of anindividual varies according to Desha, Kala, Prakriti, Ahara, etc. and accordingly,ageing process may initiate early, timely or late.Sarvadhatusara34i.e. Compactness of all body tissue is another condition where theonset of ageing will be delayed i.e. Mandajara and Chiranjivi explained by CharakaSamhita. Chakrapani opines that the time of onset of Jara (ageing) varies fromindividual to individual. It may be delayed in persons having the features of long lifespan (dheergayu), whereas early in persons having the features of medium life span(madhyamayu) and short life span (avarayu) 35.To summarize, the onset and progress of ageing depends on the factors like prakriti(constitution) and Sara (compactness of body tissue) which are geneticallypredetermined.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   14  6. Rasa Shoshana36Bhavamishra explains that, after the middle age provocated vata brings the shoshanatain poshaka rasa i.e., errors in nourishing elements, which results in inadequatenourishment to the tissues and leading to improper dhatu formation resulting indhatukshaya.7. Dhatu asamata37Sushruta Samhita explains that, because of increased Vata the adidhatu Rasa itself ismalformed and does not perform its function of “Preenana” to the rest of the dhatusand the body.Dalhana’s Commentary on this, adds that, under this state nourishmentwill be inadequate (Eeshat) and only maintains minimal cellular functions (eÉÏuÉlÉqÉɧÉÇMüUÉåiÉÏirÉjÉïÈ|).8. Agni asamata38Charaka Samhita explains that the Bala, Varna, Shourya, ojus, Ayu (longevity) aredue to sound functional condition of Agni.(C.chi.15/3) But after the middle agenaturally agni Vaishmyata occurs, which results in improper dhatu formation (vikrata)by improper digestive and metabolic activities, which ultimately resulting in Jara.9. Oja Kshaya39“iÉSpÉÉuÉÉŠ zÉÏrÉïiÉå zÉUÏUÉÍhÉ zÉUÏËUhÉÉqÉç | xÉÑ.xÉÔ. 15/26Oja is the essence of the sapta dhatu and it is responsible for shareera sthairya i.e.Compactness of body elements, by providing adequate nutritional defense to bodyelements. The kshaya of the sapta dhatu naturally leads to Oja vikriti leading toOjokshaya. Abhava of oja leads to degeneration of body.ETIOLOGY OF AKALA-JARA:
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   15  1. Charaka Samhita, while describing the scope of Rasayana chikitsa, which aids inregeneration of Dhatus, has stated that the chief contributing factor ofdeterioration of the body is ‘Gramyavasadosha.’All morbidities arise due to Gramya Ahara in those eating amla (sour), lavana(saline), katu (pungent), kshara (alkaline), shushka shaka and mamsa, tila andpishtanna bhojan, virudha,nava shuka and shami dhanya ( germinated or fresh,monocots and dicots), virudha, asatmya bhojan; klinna (decomposed),guru (heavy),putiparyushita bhojan (putrefied and stale food items), vishamashana (indulging inirregular diet or eating while the previous food is undigested), divaswapna,ativyavaya, atimadyapan, performing irregular and excessive exercise causingsanshobha (agitation) in the body and also person affected with bhaya (fear), krodha(anger), shoka (grief), lobha, and moha40.2. According to Rasaratnasamucaya41.1) Panthanam atigamana -Excess walking2) Atisheeta sevana -Excessive cold intake3) Kadanna sevana -Unwholesome food4) Vruddho angana satata sanga -Excessive indulgence in sex withelderly woman.5) Mana pratikula -Mental stress.3. Some etiological factors of Akalamrutyu (untimely death) maybe considered as etiological factors for Akala Jara42.1. ArÉjÉÉoÉsÉÉUqpÉ -Over strain,2. ArÉjÉÉÅÎalÉAprÉuÉWûUhÉ – Eating in excess of one’s own digestive power,
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   16  3. ÌuÉwÉqÉ AprÉuÉWûUhÉ – Irregular meal,4. ÌuÉwÉqÉ zÉUÏUÉxÉlÉ – Irregular posture of the body,5. AiÉÏqÉæjÉÑlÉ – Excessive indulgence in sex,6. AxÉiÉç xÉÇ´ÉrÉ – Association with wicked persons,7. ÌuÉSÉrÉïuÉåaÉÌuÉkÉÉUhÉ – Non suppression of suppressable urges,8. AÉWûÉUmÉëÌiÉMüÉUÌuÉuÉeÉïlÉ – Avoidance of food and medicine.9. When the diseases like fever are not treated properly they also lead to AkalaJara.SAMPRAPTI43Due  to  nidan  sevan,  there  will  be  a  formation  of  rasa  which  is  avishudha.This avishudha  rasa  leads  to  vitiation  of  all  the  dhatus,  resulting  in  mamsa  shithilata (muscles get flassid), sandhivimuchyana (joints get loosened), raktavidahyata (blood get  burnt),  vishyandana  of  analpa  medas  (fat  becomes  abundant  and  liquefied), majjaabhava in asthi and apravrutti of Shukra (semen does not manifest), all these changes  leads  to  ojakshaya  (ojas  deteriorates)  which  in  turn  causes  Akala  Jara. FEATURES OF JARA:  The lakshanas of Jara according to different Samhitas are given below, 1. Charaka Samhita explained that in the old age there is diminution in the dhatus and  the  functions  of  the  sense  organs,  reduction  in  the  bala  (strength),  virya (energy),  pourusha  (manliness),  parakrama  (valour),  power  of  grahana (perceiving), dharan (retention), smaran (memorizing), and vijnana (analyzing the 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   17  facts)  occurs.  During  the  old  age  the  diminution  of  qualities  of  the  dhatus (tissues) occurs with dominance of vata44.  2. Charaka Samhita mentions some other symptoms, in the chapter of Rasayana.Glani (exhaustion), tandra (laziness), nirutsaha (absence of enthusiasm), incapableof doing physical as well as mental work, loss of smruti (memory), buddhi(intelligence) and chaaya (body lustre). The man suffers from diseasesfrequently45.3. According to Sushruta Samhita during the old age there is diminution in thedhatus (tissues) and the functions of the Indriyas occur. There is marked reductionin the bala (strength), virya (energy), pourusha (manliness) and utsaha(enthusiasm).The aged person develops Vali, Palitya and Khalitya. They suffer from Kasa andShwasa. Aged is unable to perform his regular works. The old man is said to belike an old and weared house, which may collapse during any rainy season thatmeans he is unable to bear physical or mental stress46.4. Ashtanga Sangraha mentions the gradual decline in the Dhatus and the functionsof the sense and motor organs. Aged suffers from Kasa, Shwasa, Vali, Palitya,Khalitya, Agnisada, and Marutoudreka. There is laxity of mamsa and Sandhi, theskin becomes parushya and the body bents forward and the patient developskampa (tremors), nasasrava47.5. Bhavamishra explains that after 70 years decline of dhatu (tissue) indriya (senseorgans), bala (strength) and Shukra. Aged suffers from vali (wrinkling of skin),palitya (grey hair) khalitya (baldness) karma akshama (decline of functioncapacity) kasa and shwasa48.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   18  6. Haritasamhita explains that after 60yrs to 80yrs loss of strength is present in oldpeople. From 80yrs onwards there is gradual decline of other factors49.The provocated vata bring out the change in almost every body system, features ofJara can be studied in two broad categories i.e.1) Shareerika2) Manasika.Table 2. Showing the Jara LaxanasSI.No. FEATURES OF JARA C.S. Su.S. A.S B.PA) Shareerika1 Heeyamana Dhatu ( ↓ body tissue )quantative+ + + +2 Bhrushyamana dhatuguna ( ↓ bodytissue ) qualitative+ - - -3 Dhatukshaya ( ↓ body tissue ) - - + -4 Heeyamana veerya / reta ( ↓ semen ) + + - +
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   19  5 Shlatha asara Mamsa, Sandi, Asthi(flabbiness in the muscular, bony tissueand joints)- - + -6 Vali (skin wrinkle) - + + +7 Twak parusya (dry skin) - - + -8 Palitya (white hairs) - + + +9 Khalitya (hair loss) - + - +10 Heeyamana Indriya ( ↓ sensory organ ) + + + +11 Heeyamana Vachana ( ↓ speech / voice ) + - + -12 Avanama kayasya (senile kyphosis) - - + -13 Mahanya hani - + - -14 Vepathu (senile tremors) - - + -15 Agni sada - - + -16 Maruta Udreka + - + -17 Kasa, Shwasa - + + +18 Shleshma singhanodeerana - - + -19 Heeyamana bala (↓strength) + + + -20 Heeyamana poursha (↓ valour) + - - -21 Sarvakriyasamarthata (↓ physicaldisability)- + - +22 Shithilibhavanti Mamsani - + - +23 Vimuchyate Sandhaya + - - -24 Vidahyate Rakta + - - -25 Visyandanacha analpameda + - - -26 Na sandhiyate asthishu Majja + - - -27 Shukram na pravartate + - - -28 Ojokshaya + - - -29 Glani + - - -
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   20  30 Sada, Nirutsaha + - - -31 Nidra, Tandra, Alasya + - - -33 Asamartachesta of Shareera and Manas + - - -34 Nashta Smriti + - - -35 Nashta Buddhi + - - -36 Chaya Nashta + - -37 Roganam adhisthana bhuta + - - -B) Manasika1 Heeyamana Grahana(↓power ofunderstanding)+ - - -2 Heeyamana dharana (↓ retension)+ + - - -3 Heeyamana smarana (↓ memory) + - - -4 Heeyamana vijnana (↓ analyzing facts ) + - - -5 Ksheeyamana utsaha (↓ enthusiasm /depression)- + - -6 Heeyamana parakrama (↓ manobala,mental stamina)+ - - -
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   21  STATUS OF DOSHA, DHATU AND MALA IN JARA AVASTHA.Vata Dosha:The predominance of Vata in old age is universally stated in the classical texts. Theinvolvements of individual five types of Vata are not clearly mentioned.But a mantra in Atharvaveda explains the vitiation of Prana and Apana as leading to the senile state of life. (Atharva.3/11/6). The provoked vata affects adversely the strength, complexion, and happiness, the span of life, sense faculties, and functions of motor organs and gives rise to fear, anxiety,  confusion,  and  take  away  the  life50.  Ashtanga  Sangraha  has  added  the symptoms of karshya (loss of body weight), kampa (tremors), nidranasha, asthishula, Majja kshaya, constipation, moha, dainya, bhaya, shoka, pralapa51.   Pitta Dosha: Charaka  Samhita  explains  that  the  abnormal  Pitta  causes  indigestion,  diminished vision, complexion, fear, anger, and confusion52. Ashtanga Sangraha mentions that decreased pitta leads to stambha (stiffness), shaitya (cold), toda, arochaka (loss of appetite), avipaka, kampa, nakhanayan shouklyata53. Most of these symptoms are found in the aged persons.   Kapha Dosha: Charaka Samhita explains that the abnormal Kapha is responsible for the shaithilya (laxity),  karshya,  aalasya  (laziness),  klibata  (impotency)  and  agnyana54.  Ashtanga Sangraha adds bhrama (giddiness), udveshtana (calf muscle pain), anidra (insomnia), angamarda (body ache), daha (burning sensation), toda (pricking sensation), vepana (tremors),  hradadrava  (palpitations),  and  sandhishaithilya  (looseness  of  joints)  are 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   22  the  Kapha  Kshaya  Lakshanas55.  Most  of  these  symptoms  are  found  in  the  aged persons.   STATUS OF DHATUS IN JARA:Ancient scholars in all places mentioned gradual decline in the Dhatu in increasingage. Charaka Samhita explains “WûÏrÉqÉÉlÉkÉÉiÉÑ” and pÉëzrÉqÉÉlÉkÉÉiÉÑaÉÑhÉ i.e.both quantitativeand qualitative decrease in Dhatus occurs during old age. Sushruta Samhita mentionedthat the period of old age is marked with gradual decrease in Dhatu “ͤÉrÉqÉÉlÉ kÉÉiÉÑ”(Su.Su.35/29). Ashtanga Sangraha also shares the same notion by stating ‘ͤÉrÉqÉÉlÉ kÉÉiÉÑaÉÑhÉ’ (A.S.8/22).Sara  indicates  the  best  state  of  individual  Dhatu  and  this  special  physical character rather exists by birth. Ashtanga Sangraha has mentioned “zsÉjÉ xÉÉU” as one of the sign of Jara. This suggest disturbance in all the Dhatu. (A.S.8/22). The  classical  texts  have  not  detailed  the  role  of  individual  Dhatu  in  the  Jara.  But more or less, the Kshaya of all the Dhatu is bound to occur, as Bhela Samhita coins the term “xÉuÉïkÉÉiÉÑ mÉËU¤ÉrÉÉiÉ” it means that the depletion of all Dhatu results during Jara Process56.   STATUS OF UPADHATUS IN JARA: Upadhatus, the products of the Dhatus also get affected in Jara.1. “Rajonivrutti” is found in all the aged females.2. Twak parushata and vali are the features of Jara;3. The sign “Kayasya namanam” is indicative Snayu involvement in the Jara.4. “Sandhi shaithilya” i.e., flabbiness of joints.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   23  5. Kesha (Khalitya and Palitya).STATUS OF INDRIYAS IN JARA: Charaka Samhita explains that xÉuÉåïÎlSìrÉÉhÉÉqÉѱÉåeÉMüÈ, xÉuÉåïÎlSìrÉÉjÉÉïlÉÉqÉÍpÉuÉÉåRûÉÈ all thesensory perceptions are maintained normally when vata is in normal status. (Vatacoordinates all the sense faculties and helps in enjoyment of their objects).xÉuÉåïÎlSìrÉÉhrÉÑmÉWûÎliÉ i.e., deterioration of sense organs is the function of provocated vata57.Sushruta Samhita explains that ´ÉÉå§ÉÉÌSÎwuÉÎlSìrÉuÉkÉÇ MÑürÉÉïiÉ M×ü®: xÉqÉÏUhÉ |58i.e., whenprovocated vata lodges in the sensory organs like - eye, ear, nose, tongue, skin resultsin destruction of these sense organs.STATUS OF MANAS IN JARACharaka Samhita explains that normal Vata restrains and impels the mentalactivities.“ÌlÉrÉliÉÉ mÉëhÉåiÉÉ cÉ qÉlÉxÉÈ |” and the provocated vata results in “qÉlÉÉåurÉÉWûwÉïÌiÉ” i.e., impairedmental function. This leads to diminution of grahana (grasping), dharana (retention)smarana (memorizing), Vachana (voice), Vignana (analyzing the facts).DECADE WISE AGEING PROCESSAyurvedic literature gives a detailed description of the biological aspects of Ageing including  growth,  puberty  and  senility.  Though  the  classics  have  categorized  Vaya into  Balya,  Madhya  and  Vriddha  Avastha,  they  have  observed  changes  occurring during growth and also the initiation of decrement of certain particular faculties of the body in each decade. 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   24  Ashtanga Sangraha (A.xÉÇ.zÉÉ.8/25) was the first one to record such an observation, which was followed later by Sharangadhara Samhita. (zÉÉ.mÉÔ.ZÉÇ.6/20). Table 3. Showing decade wise ageing process             VYADHIS IN JARA:Charaka Samhita mentioned Jara kasa61and Jarajanya klaibya62these two vydhis inold age, Sushruta Samhita mentioned Jarashosha63vyadhi in old age, apart from thisOld age people are more prone to following Vatananatmaja vikaras64. Padashula,Nakhabheda, Janubheda, Januvishlesha, Kubjatva, Dantashaithilya, Mukhashosha,LOSS OF TISSUESDecadeAshtanga Sangraha59SharangadharaSamhita601 Balya (Childhood) Balya (Childhood)2 Vrudhi (Growth) Vrudhi (Growth)3 Prabha (Complexion) Chavi (Complexion)4 Medha (Intellect) Medha (Intellect)5 Twak (Skin) Twak (Skin)6 Shukra Drushti (Vision)7 Drushti (Vision) Shukra8 Shruti(Hearing) Vikrama (Velour)9 Mana (Mind) Budhi (Knowledge)10 Sarvendriya (Sensory & Motororgans)Karmendriya (Motororgans)11 - Mana (Mind)12 - Jivita (Life)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   25  Badhirya, Timira, Bhrama, Vepathu, Udavarta, Trikagraha, Vishada, Aswapna,Anavasthitachita.UPDRAVAS IN JARAMüÉxÉμÉÉxÉÉÌS EmÉSìuÉÉ ..... (xÉÑ.xÉÔ. 35/29) Sushruta Samhita explains that, kasa and shwasa in aged individual’s results as an upadrava (complication). SADHYA- ASADHYATAuÉ×kSÉå rÉÉmrÉÉlÉÉÇ.... cÉ.xÉÔ.25/40Charaka Samhita while describing the best bhavas (Agrasangraha) mentioned Jara as ‘Yapya’ vyadhi.   CHIKITSA  Longivity is human desire and quest for long and happy life has oldest history in India it is well supported by Vedic sources and vast oriental sources of Indian literature. AWÇû ÌWû kÉluÉliÉËUUÉÌSSåuÉÉå eÉUÉÂeÉÉqÉ×irÉÑWûUÉåÅqÉUÉhÉÉqÉ |Lord Dhanavantari, while explaining the intention of his descent to the earth, said “I Dhanavantari the foremost of the Gods having cured the Gods from ageing, disease and death,” Therefore Ayurveda itself is seen to have been evolved to ease humans from Jara and associated vikaras. In Ayurveda, there is always given due importance to Prevention than Cure. So Acharyas have given more importance to Healthy Life Style than medication. The 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   26  very first chapter of Charaka Samhita named “SÏbÉï‹ÏÌuÉiÉÏrÉqÉkrÉÉrÉÇ” indicates from very beginning to live long is the one of the most desirable thing.  For this purpose, Charaka Samhita has given ‘Swastha Chatushka’ in early chapters ofsutra sthana and described different ways to away from Akala Jara.OBJECTIVES OF JARA CHIKITSA To avoid Akala Jara Delay the Kalaja Jara. Chikitsa of Akala and Kalaja Jara.To avoid Akala Jara and Delay the Kalaja JaraAHARACharaka Samhita in Shareeravrudhikara bhava (C.Sha.6/12) mentioned thatAharasousthavam contribute the development of body. Aharasousthavam means theexcellent properties of food. Charaka Samhita mentioned the body as well as diseasesis caused by food; wholesome and unwholesome food is responsible for happinessand misery respectively. Chakrapani opines that vastu means Shareera65.In Ayurvedic literature detailed description of Dietary Habits for maintaining Healthas well as curing the diseases are explained. Some of the references of Dietary habitsrelated to Healthy Ageing are given below:1. Food is the basic need of all living beings.2. Quantity of diet as per Digestive capacity. (Ch.Su.5/3)3. Scientific explanation of light and heavy diet (Laghu & Guru). Ch.Su.5/64. Bala, Varna, Sukha Ayu are the advantages of taking food in proper quantity.Ch.Su.5/8
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   27  5. Indication of food, which can be used forever to maintenance of health andprophylaction of disease. (satmya & asatmya) Ch.Su.5/10-14,6/496. Description of Dietetic Incompatibilities (Viruddha Ahara). Ch.Su.267. Detailed description of properties of diets in the chapter of‘Annapanavidhi’.8. Scientific explanation of ‘Ashtavidha Ahara Vidhi Visheshayatana’ and itsadvantages. (Ch.Vi.1)9. Effect of Mental Status on Digestion and Amotpati. (Ch.Vi.2) VIHARAIn Ayurveda there is a unique description of Lifestyle in Preventive Akala Jara anddelaying the process of Kalaja Jara. Some references are given below:1. DINCHARYA:- Description of Personal Hygiene for routine life as Dincharyaand its scientific explanations.(Ch.Su.5)Table 4. Showing dincharya and its benifitsSI.NO. DINCHARYA BENEFITS1 Ushapana (intake of water in earlymorning)66Delay Jara process ….2 Gandusha Prevents dantakshaya…3 Abhyanga Shiroabhyanga Karnapooran PadaabhyangaJarahara, Shramahara,Vatahara…Prevents Khalitya, Palitya…Prevents Badhirya….Prevents sira, snayu sankocha andpadasuptata.4 Nasya Even though, he might be growing old, oldage does not affect his head in the form ofkhalitya, palitya.5 Vyayama Delay Jara process…..6 Udvartan Angasthairyata7 Snana Vrushya, Ayushya…8 Shubhravastra dharan Ayushya…
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   28  9 Gandhamalyadi dharan Ayushya, soumanasya10 Ratna dharan Ayushya, Ojasya11 Kesha, shmashru, nakhadi chedan Ayushya…12 Padatra dharan Chakshushya, Balya…2. RUTUSHODHANA, RASAYANA AND VRUSHYA YOGAS.1. Shodhana Kala: In the month of Chaitra, Shravana, Margasira one shouldadminister Shodhana therapies. (Approximately March-April, July-August andNovember-December respectively).2. Poorvakarma: Snehana and Swedana,3. Pradhanakarma: Vamana, Virechana, Basti and Nasya therapies in propersequence.4. Paschatakarma: Rasayana and Vajikarana Yoga’s.Benefits:UÉåaÉÉxiÉjÉÉ lÉ eÉÉrÉliÉå mÉëM×üÌiÉxjÉåwÉÑ kÉÉiÉÑwÉÑ |kÉÉiÉuɶÉÉÍpÉuÉkÉïliÉå eÉUÉ qÉÉl±qÉÑmÉæÌiÉ cÉ || cÉ.xÉÔ.7/46-491. Not suffers from any diseases.2. The tissue elements are maintained in homeostasis3. There is proper growth of tissue elements4. The process of Jara is delayed.3. Ayuvardhaka gana67Eating after the digestion of a previous meal, non-suppression of natural urges of thebody, ahimsa (non-violence), brahmacharya ( celibacy), sahas varjan (self control andrefraining from rash and hazardous undertakings), should be considered the key tolong life.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   29  4. Adharaneeya Vega68iÉxqÉÉÎkS uÉåaÉÇ lÉ ÌuÉkÉÉUrÉåiÉç lÉUÉå rÉ CcNåûÌSWû SÏbÉïqÉÉrÉÑÈ | pÉå.xÉ.xÉÔ.6/51Bhela Samhita explains that a person who desires long life in this world should neverhold back the impending urges.5. Dharaneeya Vega69LiÉkSÉUrÉiÉÉå ½xrÉ oÉsÉqÉÉrÉÑ¶É uÉkÉïiÉå | pÉå.xÉ.xÉÔ.6/7-8Bhela Samhita explains that the wise person should suppress the urge that has comeabout of greed, passion, and infatuation, fear, strong and intense desire, grieving,arrogance, prestige and valour, as he suppresses these urges his strength and span oflife flourish forth.6. Sadvrutta70AÉrÉÑUÉUÉåarÉqÉæμÉrÉïÇ rÉzÉÉå sÉÉåMüÉÇ¶É zÉÉμÉiÉÉqÉ | A.¾èû.xÉÔ.2/48Ashtanga Hrudaya explain that, who adopt the rules of good conduct he will (surely)attain long life, health, reputation and also the eternal world.7. Trayo Upasthambha71Ashtanga Hrudaya explains that, Ahara, Nidra, Brahamachrya properly indulged,supports the body constantly just like the house is supported by the pillars.8. Achara Rasayana72AÉcÉÉUssÉpÉiÉå AÉrÉÑ | WåûqÉÉSìÏ on A.¾èû.xÉÔ.2/1
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   30  Achara Rasayana is a means to acquire Rasayana effect through social and personalconduct. Achara Rasayana mentioned by Charaka Samhita broadly can be studied in 3aspects73.a. Personal behavior: satyavadi, akrodha, nivrutta madya maithuna, japa, soucha,nitya tapasvi. Samjagaranswapna, Yuktigna.b. Social behavior: Priyavadi, ahimsa karma, respect the Brahman, Acharya, andVriddha.c. Satvika Ahara: daily intake of ghee and milk.9. Vayasthapana74uÉrÉÈxjÉÉmÉlÉÇ mÉëzÉxiÉiÉÂhÉuÉrÉÈxjÉÉmÉlÉiÉÇÈ rÉSÒcrÉiÉå-“AxrÉ mÉërÉÉåaÉɲwÉïzÉiÉqÉeÉUÇ cÉ uÉrÉÎxiɸÌiÉ”||Chakrapani explained Vayasthapana as that which maintains Youthfulness.RASAYANA:Definition:1. Charaka Samhita defines that “A procedure by which Rasadi sapta dhatu aresanctified in all respect through proper nourishment is known as Rasayana”75.2. Sushrutasahita while making a reference to the branch, terms it to be the scienceof Rejuvenation, which is the attainment of longevity, possessing anaboliccapacity improvement of mental faculty and also gaining immunity against andovercoming any existing diseases76.3. Sharangadhara explains Rasayana as the therapy which destroys age relateddisease77.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   31  4. Yoga Ratnakar defines Rasayana as “the medicines which help to prevent old ageand disease, stabilizes age, good for eyes and help to increase dhatus and isspermatogenic” .78Types of Rasayana79A comprehensive classification of Rasayana is available in Sushruta Samhita whichwas further improved by the commentator Dalhana. Following is the most rationalclassification of Rasayana according to the classical description.A) According to mode of administrationi) Kutipraveshika Rasayanaii) Vatatapika RasayanaB) According to utilityi) Kamya Rasayana-ii) Naimittika Rasayana - Shilajatu, Bhalattaka, Tuvaraka.iii) Ajasrika Rasayana – Kshira, Ghrita.C) According to the effect(1) Samshodhana Rasayana – Sasyadi Rasayana(2) Samshamana Rasayana – Nagabaladi Rasayana.D) According to usei. Sarvopaghata shamaneeya- pacifying all the diseases,ii. Medhaayushya Kameeya- improving the intellect faculties
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   32  iii. Swabhava vyadhi Pratishedhaniya- prevention of naturaldisordersiv. Nivrutta Santapeeya- eliminating the diseases.Rasayana Benefits1. Charaka Samhita describes the uses of Rasayana therapy as it provides Dheergayu(longevity), Smriti, medha (promotes memory, intellect), Arogya (health), Tarunyavaya (youthful age), Prabha (excellence of lusture), Varna (complexion) andSwaroudarya (voice), Deha, indriyabala (strength of physique and sense organ),Vakssiddhi (successful words), pranati (politeness) and kanti (brilliance)80.2. Charaka Samhita further adds, Rasayana therapy is like Amruta (Nectar), achintyaadbhuta prabhava (having incomprehensible miraculous effects), promotes life-span,provides health; vayasthapana (sustain youthful age), nidra tandra, shrama,klama,aalasya dourbalya hara, anilapittakapha samyakara (restores equilibrium of Vata,Pitta, Kapha), sthairyakar (brings stability), abadhamamsahara (alleviates laxity ofmuscles), antaragnisandhukshana (kindles internal fire) and provides excellent lustre,complexion and voice. By using Rasayana the great sages like Chyavana etc. regainedyouthful age and became charming for the women, they attainedsusamhatsthirashareera (firm, even and well divided muscles); compact and stablephysique; suprasanna balavarnendriya (blossomed strength, complexion andsenses);sarvatra apratihatkrama (uninterrupted prowess) and kleshasahacha(endurance)81.lÉ MåüuÉsÉ SÏbÉïqÉÉrÉÑUzlÉÑiÉå lÉ eÉUÉ lÉ cÉ SÉæoÉïsrÉÇ lÉÉiÉÑrÉïÇ ÌlÉkÉlÉÇ cÉ | cÉ.ÍcÉ. 1/1/10One who uses the Rasayana treatment methodically attains not only long life but alsothe auspicious status enjoyed by the godly sages and finally oneness with
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   33  indestructible God.3. Dalhana explains the merits of Rasayana as, it increases and maintains the optimumlevel of all body elements prevents and cures senility (Jarapaharana) diseases.(Rogapaharana), further Dalhana commenting on Su. Chi. 27/1-2 says that merits ofRasayana as, Vardhaka means which increases, Sthapaka means which stabilizes andApraptaprapaka means which gives additional endowments. 82,83INDICATION OF RASAYANA IN JARASushruta Samhita84and Ashtangahrudaya85indicated Rasayana to be administered inpoorvavaya and madhyamavaya.Charaka Samhita86explains that the diseases arising out of temporal factors that bringabout old age and death are to be considered as natural ones and naturalmanifestations are irremediable.But there are certain specific indications in the classics which admit the Rasayanaeven for treating Swabhavika Jara those are as follows,Chakrapani commentary on Swabhava nishpratikriyaha i.e. The word ‘Nishpratikriya’means which can’t be counteracted by ordinary treatment but amenable to the use ofRasayana, the senile stage of Chyavana regained his youth by consuming Rasayanatherapy”.Chakrapani concludes that “Natural ageing is inevitable because as long as thepotency of Rasayana exists in the body so long the cellular senescence will be
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   34  protected, but the process of senescence will be initiated when the potency ofRasayana goes off.”Yogindranatha clarifies it further. He says that nature can’t be counteracted even byRasayana which can check senility if it comes prematurely, so premature death canalso be checked.Chakrapani commenting on Swasthya oorjaskara says that this therapy is treat thenatural ageing and to promote quality life.Swabhava vyadhi pratishedhaniya Rasayana i.e., Rasayana intended to treat naturaldiseases is one amongst the 4 types of Rasayana explained by Sushruta Samhita.Dalhana explains that the specialist those specialization in this type of Rasayana thatalleviates the natural diseases (swabhavika vyadhi nivarana vaishishtoushadhachintaka).To summarise the above references, the Rasayana therapy is indicated even in naturalageing.RasoushadhiRasashastra is a specialized field of Ayurvedic pharmaceutics which deals withmetals, minerals and herbal products for therapeutic purpose.eÉUÉÂ…ûqÉ×irÉÑlÉÉzÉÉrÉ UxrÉiÉå uÉÉ UxÉÉå qÉiÉÈ|SåWûsÉÉåWûqÉrÉÏÇ ÍxÉÎkSÇ xÉÔiÉå xÉÔiÉxiÉiÉÈ xqÉ×iÉÈ| U.U.xÉ. 1/76-77The objects of Rasashastra are Dhatu-Vada and Deha-Vada.Deha Vada: To achieve the perfect health and lead a long life without being afflictedwith diseases87.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   35  Rasaratnasamuchaya88explains the following benefits of the Rasoushadhi,1. The Murchita Parada destroys all the diseases; The Bandha Parada responsiblefor emancipation, Mrita Parada brings about immortality (long-life) (U.U.xÉ. 1/34-35).2. For the endurance or stability of the body neither herbal medicines nor metallicmedicines as Rasayana are capable. For such a Rasayana substances themselvesareunreliable, they may be burnt in the fire, get soaked in the water, dry up in thesunrays. But as mercury cannot be affected with such things, it is superior andsupreme. ( U.U.xÉ. 1/38-39).3. LMüÉåÅxÉÉæ UxÉUÉeÉÈ zÉUÏUqÉeÉUÉqÉUÇ MÑüÂiÉå | U.U.xÉ. 1/42Parada makes the body ageless and immortal.CHIKITSA OF KALAJA AND AKALAJA JARA89Acharya Dalhana explained that there is no cure for Kalaja Jara; it is Yapya i.e., the illeffects of Jara can be checked and its progress can be slowed down to some extent byusing Ahara, Rasayana etc.Akalaja Jara can be treated according to the dosha involved or vyadhi associated withrespective treatment and Rasayana dravyas.VATAHARA:uÉÉkSïMåü uÉkSïqÉÉlÉålÉ uÉÉrÉÑlÉÉ UxÉzÉÉåwÉhÉÉiÉ |lÉ iÉjÉÉ kÉÉiÉÑuÉ×kSÏÈ xrÉɨÉiɧÉÉÌlÉsÉÇ eÉrÉåiÉ || pÉÉ.mÉë.3/196
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   36  From Doshic point of view, Vata dosha is the key culprit in almost all geriatricproblems, since the basic features like Chestha hani, Kshayaja vikaras, Asthivikaraetc. are directly interlinked with Gati, Dhatukshaya, Anavasthita and Vishamata ofVatadosha. Therefore Vatashamana should be the primary aim of treatment.Vatasyaupakrama90The remedy consisting of contrast substances with respect to qualities and actions ofVata and opposite measures to that aggravating etiological factors and suspension ofall exciting or triggering causes should be undertaken.They are as follows,1. Dravya - Madhura, Amla, and Lavana rasa drugs,2. Guna – Snigdha and Ushna qualities.3. Karma – Snehana, Swedana, Asthapana, Anuvasana, Nasya.4. Ahara and Carya – Hemanta Rutucarya, Utsadana, Parisheka, Avagaha, Mardana,Samvahana, Veshtana and diet and articles with hot and unctuous properties,wines. Fats from different sources mixed with drugs having digestive, stimulant,carminative, vata-alleviating and purgative properties-they may be boiled hundredand thousand times and be used for being administered in different ways, viz.internal use, massage, enema etc.5. Basti and regimen to be adopted along with it, the number of Basti may beaccording to the description available in Siddhi sthana.AGNIRAKSHAAgnimandya and ama occurring in Vriddhas are corrected by Agni regulativetreatment i.e. Deepana and Pachana treatment.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   37  BASTIPRASHASTIoÉÎxiÉuÉÉïiÉWûUÉhÉÉÇ | cÉ.xÉÔ.25/40Basti deserves special mention among the Panchakarmas as being the most indicatedprocedure in old people and yielding a wide range of benefits.The indications of Basti with special reference to old age problems are;Anarha for Vamana and Virechana, Praheena Dhatubala, Conditions of Sankocha,Stabdhata and ruk, Vatarogas, Shakha vata, Urdhawa jatruvikaras, Koshtarogas,Marma rogas, Sarvanga rogas.etcIt is therefore Basti is a multifaceted and highly appropriate therapeutic measure inthe conditions occurring in Vriddhas.The types of Basti that may be used are:1. Niruha Basti: - due to its properties of Vayasthapana, Ayusthapana.2. Anuvasana Basti: - due to its property of Vatahara and Brimhana.3. Yapana Basti:-due to its property of Ayuyapana.4. Siddha Basti:-due to its properties of Arogyakarana and Varnakarana.5. Matra Basti:-due to its properties of Balya, Alpagnisandhukshana, and specialreference to Vriddhas (Vridha vyavahara siddhacha).In view of the above, it is no exaggeration to say:“iÉxqÉÉΊÌMüixÉÉkÉïÍqÉÌiÉ oÉëÑuÉÎliÉ xÉuÉÉï ÍcÉÌMüixÉÉqÉÌmÉ oÉÎxiÉqÉåMåü ||” cÉ.ÍxÉ.1/39.Basti constitutes half and sometimes whole of the treatment.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   38  Supportive therapySuch as Dhatu pushtikar measures, Ojovardhaka measures and srotoshodhakameasures.Matra in Vrudhavastha91Kashyapa Samhita explains that except in case of doubt in exceptional circumstancesthe dose of drug of old persons is that of the persons of sixteen years of age.Afterwards it gradually decreases and in hundred or more than hundred years of agethe dose like Kshiraannada i.e. upto 2 years of age is desired (MüÉ.ÎZÉ.3/77).Oushadha Sevankala in Vrudhavastha92Kashyapa Samhita mentioned that in old age the medicine used along with the mealsis beneficial for protection of strength and fire.Anupana in Vrudhavastha93Milk is best suited just like Nectar for the emaciated, the aged and childrens.Contraindication of continuous use of medicine in old age.Kashyapa Samhita explains that, to emaciated, very old, angry persons having loss ofdhatus, indriyas, ojus, medicine taken solely destroys them in the same way as sundesiccates little water (MüÉ.ÎZÉ.3/60).Table 5.Showing Indications and contraindications in old ageSI.NO. INDICATIONS CONTRAINDICATIONS
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   39  1 Madhurarasa -Aayushya, Jeevan,PreenanAnashana – Ayushyahrasakar.2 Puransarpi–Shoshaghna, Medhakar,Timirghna.Ekrasaabhyasa – Dourbalyakaranam.3 Taila – Vataharanam Kshara ati sevan – Kesha, Akshi,Pumstvaghat.4 Kshira – Jeevaniya,Vayasthapanam.Atilavana sevan – Akala Khalitya,Palitya, Vali.AHARA5 Kalabhojan -ArogyakaranamGramya Ahara – Sarvadoshaprakopanam.6 Brahmacharya -AyushyakaramAtivyavaya7 Sahas varjan – JeevitRakshanamAtichankraman8 Jeerne bhojan –AyuvardhanamUchair bhashan9 Ushnodak Snana –Shramahar.Ativyayama10 Divaswapna Vegadharan - Anarogyakaranam11 - BharavahanVIHAR12 - Exposure to Purovata, Atapa, Rajha,Tushar, Parusha Anil.13 Bruhanam Achasneha14 Snehan, Sadyasnehan Tikshna oushadha15 Mrudu Aoushadha Langhana16 Basti- Vataharanam Siravyadha17 Pratimarsha Nasya Vamana18 Sabhakta oushadha Virechan19 Daran karma Abhakta oushadha20 Sweda -MardavakaranamPaneeya KsharakarmaKARMA21 Gandusha – Agnikarma
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   40  Dantabalaruchikar.22 - Dhumrapan23 - DantoudharanTable 6. Showing List of rasayana Yogas indicated in jaraSL.NO.YOGA SL.NO.YOGA1 Amlakasaya Brahma rasayana(C.S.)27 Swagata jaranashaka beejakarasayana (A.H.)2 Amlakasaya Brahma rasayana(C.S.)28 Prathama triphala rasayana(R.R.S.)3 Amlakasaya Brahma rasayana(C.S.)29 Dvitiya triphala rasayana (R.R.S.)4 Amlakasaya Brahma rasayana(C.S.)30 Triteeya triphala rasayana(R.R.S.)5 Triphala rasayana (C.S.) 31 Sushruta narikela prayoga(R.R.S.)6 Indrokta rasayana (C.S.) 32 Vardhakya hara rasayana(R.R.S.)7 Prathama bramharasayana(C.S.)33 Udayadikiya rasayana (R.R.S.)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   41  8 Chavana Prasha (C.S.) 34 Sarva roga hara rasayana (R.R.S.)9 Chatur amalaka rasayana(C.S.)35 Masika rasayana (R.R.S.)10 Indra rasayana (C.S.) 36 Shanmasika rasayana (R.R.S.)11 Somarasayana (S.S.) 37 Pippalyadi rasayana (R.R.S.)12 Swarnamakshika yoga (A.S.) 38 Shasthyadhika trishat varshyuskara rasayana (R.R.S.)13 Jaranashaka makshika yoga(A.S.)39 Sahasravararshayusikara rasayana(R.R.S.)14 Haritaki yoga (A.S.) 40 Shadango rasayana (R.R.S.)15 Triphala yoga (A.S.) 41 Ttiteeya kanta rasayana (R.R.S.)16 Trushanyadi yoga (A.S.) 42 Pathya rasayana (C.D.)17 Amalaki rasayana(A.H.) 43 Ashwagandha rasayana (C.D.)18 Ashwagandha Choorna (A.H.) 44 Jala nasya (C.D.)19 Punarnava yoga (A.H.) 45 Prathahakala jala nasya (B.R.)20 Shilajeetu(A.H.) 46 Nirgundi kalpa (B.R.)21 Vaarhikanda yoga (A.H.) 47 Shri mrutyunjaya tantroka amrutavartika (B.R)22 Asanadi choorna yoga(A.H.) 48 Narayana taila (B.R.)23 Tuvaraka taila(A.H.) 49 Bringarajadi choorna (B.R.)24 Dhatri rasayana (A.H.) 50 Vruddha daruka rasayana (B.R.)25 Beejaka rasayana (A.H.) 51 Amrutarnava rasa (B. R.)26 Jaranashaka vidangadirasayana (A.H.)Medicinal plants in geriatric health care: an evidence based approach; CCRAS200894Amalaki Arjuna Ashvagandha AsthisamharaApamarga Brahmi Bala GuduchiEranda Gokshura Guggulu Haritaki
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   42  Haridra Hingu Jatamamsi KantakariKharjura Sallaki Lashuna MandukaparniMeshasringi Narikela Nirgundi PashanabhedaPippali Punarnava Pushkarmula SalaparniSarpagandha Shatavari Sunthi TagaraTulasi Varuna Vidari YastimadhuGERIATRICSDerivation:Greek “geron,”oldman, and “iatros,” healer95.Definition:The branch of medicine specialiased in the health and illness of old age and theappropriate care and services95.Old age Synonyms: ageing, over-the-hill, senescent, unyoung, aged, along in years,ancient, broken down, debilitated, decrepit, elderly, enfeebled, exhausted,experienced, fossil, geriatric , getting on, gray, hoary, impaired, inactive, infirm,matured, olden, past ones prime, seasoned, senile, skilled, superannuated, venerable,versed, veteran, wasted96.OLD AGE97
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   43  World Health Organization breaks down “old age,” classifying persons 60 to 74 yearsof age as the young-old, those 75 to 84 as the old-old, and those 85 years and older asthe oldest-old.Centenarians, are individuals 100 years old and older.Brief Glossary of Ageing-Related Terms971. Ageing - Latin “aetas.” The lifelong process of growing older at cellular, organ, orwhole-body level throughout the life span.2. Gerontology - Greek “geron,” old man, and “logos,” knowledge. Themultidisciplinary study of all aspects of ageing, including health, biological,sociological, psychological, economic, behavioral, and environmental factors.3. Senescence - Latin “senex,” old man. The condition of growing, limited to oldyears.4. Life span - The duration of the life of an individual/organism in a particularenvironment and/or under specific circumstances.5. Life expectancy - The average amount of time of life remaining for a populationwhose members all have the same birth date and based on a given set of agespecific death rates (generally the mortality conditions existing in the periodmentioned).6. Active life expectancy - As above, with the additional idea that the years of lifebe free of a special level of disability.7. Longevity - Long duration of an individual’s life; the condition of being “long-lived,” also often used as a synonym for life span.THEORIES OF AGEING98Many scientists had tried and still trying to search out the mystery of Ageing throughcertain Theories. The purpose of this section is to provide a brief overview of the
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   44  main theories of ageing. It begins with orderly — molecular, cellular, systemic, andevolutionary.Classification and brief description of main theories of ageingA. Molecular:1. Codon restriction - Fidelity and/or accuracy of mRNA message translation isimpaired with ageing due to cell inability to decode the triple codons (bases) inmRNA molecules.2. Somatic mutation - Type of stochastic theory of ageing that assumes that anaccumulation of environmental insults eventually reaches a level incompatiblewith life, primarily because of genetic damage.3. Error catastrophe - Errors in information transfer due to alterations in RNApolymerase and tRNA synthetase may increase with age, resulting in increasedproduction of abnormal proteins.4. Gene regulation - Ageing is caused by changes in the expression of genesregulating both development and ageing,5. Dysdifferentiation - Gradual accumulation of random molecular damage impairsregulation of gene expression.B. Cellular:1. Wear and tear - Intrinsic and extrinsic factors influence life span.2. Free radical accumulation - Oxidative metabolism produces free radicals thatare highly reactive and thus damage DNA and/ or proteins and thus degrade thesystem structure and function.3. Apoptosis - Process of systematically dismantling key cellular components as theoutcome of a programmed intracellular cascade of genetically determined steps.C. System :
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   45  1. Rate-of-living - An old theory that assumes that there is a certain number ofcalories or heart beats allotted to an individual and the faster these are used, theshorter the life.2. Neuroendocrine - Alterations in either the number or the sensitivity of variousneuroendocrine receptors give rise to homeostatic or homodynamic changes thatresult in senescence.3. Immunologic - Immune system reduces its defenses against antigens, resulting inan increasing incidence of infections and autoimmune diseases.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   46  D. Evolutionary:1. Antagonistic pleiotropy - Alleles that have beneficial effects on fitness at youngages can also have deleterious effects on fitness later in life.2. Mutation accumulation - The force of natural selection declines at older ages toa point where it has little impact on recurrent deleterious mutations, with effectsconfined to late life.3. Disposable soma - Preferential allocation of energy resources for reproduction tothe detriment of maintenance and survival of somatic cells.Premature ageing99Changes  in  the  organism  associated  with  senescence,  occurring  at  an  accelerated rate.  Types of Premature ageing100 1. Child progeria (Hutchinson ‐ Gilford syndrome) ‐ ageing starts around 4 years age, or 10‐12 years. The affected child shows grey hairs, baldness, and loss of fat, atherosclerosis etc. death results at puberty. 2. Adult Progeria (Werner’s syndrome) – starts in early adult life as early as 40 years of age, follow rapid progression.  EFFECT OF AGEING ON SPECIFIC ORGANS AND SYSTEMSCELL101Cell age and die just like the whole organism, but do it more rapidly and at differentrates depending upon the individual organ.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   47  For e.g. the cells of the epidermis shed every few days, while the R.B.C. lives forabout 4 months.Cells can die by either of two fundamentally different mechanisms:1. Apoptosis or programmed cell death, which entails controlled reactions thatprevent the dispersion of cellular contents into the surrounding tissue.2. Necrosis which entails cell lysis into the surrounding tissue.Both modes of cell death may contribute to age-related pathologies.RESPIRATORY SYSTEM 1021. The most characteristic change in the chest wall with advancing age is stiffening.2. Cartilages thicken and calcify, and spinal ligaments and joints become stiffer.3. The primary internal change in the lungs is the loss of the elastic recoil. The resultis a modest expansion of the chest wall with the appearance of a mild barrel chest.4. The lungs become more voluminous, and the alveolar ducts and respiratorybronchioles are enlarged, while the alveoli become shallower and more flat withloss of septal tissue.5. Although resting lung mechanics do not seem to change in any major way, theloss of maximum breathing capacity declines by approximately 40%.6. At the alveolar level, the capacity to exchange oxygen and carbon monoxidedecreases by approximately 50% between the ages of 30 and 65 years.7. Pulmonary reflexes such as coughing and Ciliary function decrease, predisposingelderly individuals to the pooling of secretions.8. Progressive reduction in arterial PO2.Age-Related Respiratory Syndromes
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   48  Shortness of breath, Clinical hypoxia, Aspiration pneumonia, Exertional dyspnea iscommon among the elderly.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   49  GASTROINTESTINAL SYSTEM 103Age-related changes in the mouth include slower production of dentine, shrinkage ofthe root pulp, and decreasing bone density of the jaw. The loss of bone and tonguemusculature makes the tongue appear to be enlarged. The esophagus seems tofunction relatively normally. The strength of muscle contraction declines, however,and peristaltic waves slow with advancing age. There is also a tendency for the loweresophageal sphincter to become lax. The gastric mucosa secretes less acid withadvancing age. Most studies suggest that delayed gastric emptying is a feature ofageing, leading to a sense of false or early satiety, which can impair subsequent foodingestion. Digestion depends upon a number of enzymatic processes under neural andhormonal stimuli, which can be affected in the elderly. In addition to physiologicchanges with ageing, the stomach undergoes pathologic changes, among which themost common are gastritis and peptic ulcer disease.Liver:-Changes with ageing may reflect degenerative processes (e.g., reduced liverweight, cell loss, and decreased mitochondrial number) or compensatory processes(e.g., increased cellular and mitochondrial size). If this is the case and that agedhepatic cells are active is supported by the increased activity of some enzymes (e.g.,succinic dehydrogenase).Alteration of hepatic structure and enzymatic functions withageing are Moderate.Biliary disease: An increasing incidence of stones in bile ducts and gallbladder withageing has been well documented. With this increase, the incidence of relatedcomplications (e.g., jaundice, pancreatitis, cholecystitis, liver abscesses, and systemicsepsis) also rises.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   50  Exocrine pancreas:-The senile gland is smaller, harder than normal (due toincreasing fibrosis), and yellow-brown (due to accumulation of lipofuscin). Of themajor enzymes, some (amylase) remain constant, whereas others (lipase, trypsin)decrease dramatically. Secretin-stimulated pancreatic juice and bicarbonateconcentration remain unchanged.Intestine:-Ageing is associated with a significant reduction in small intestinal surfacearea with the consequence of reduced absorption of some dietary components, such ascalcium. Colonic function declines with advancing age. Overall alterations of theshape of the villi and the microvilli Increase in collagen, Mitochondrial changes,Lengthening of crypts, Prolonged replication time of the crypt stem cells. Evacuationis characteristically slower with advancing age. Stool frequency tends to decline, andhardness of stools seems to increase with advancing age.Age-Related Gastroenterological SyndromesConstipation, Recession of the gingivae (gums) occurs in all elderly. Chronicperiodontal disease, xerostomia, mucositis and mucosal atrophy, leukoplakia, andmalignant neoplasias are the most common. Dysphagia, Regurgitation, chest pain, andheartburn are fairly common in the geriatric population, Carcinoma of the largebowel, colorectal cancer, is the second (after lung carcinoma) most commonmalignancy in individuals over 70 years of age.CARDIOVASCULAR SYSTEM104Cardiac structural changes may be caused by the ageing process itself or may besecondary to disease.1. The resting heart rate slows slightly with advancing age.2. Reduction in cardiac muscle size.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   51  3. The loss of sinus node pacemaker cells—up to 90% at 80 years—contributes tothese changes. There also are changes in central and baroreflex-mediated heartrate control.4. Heart valves thicken and stiffen, particularly in the mitral and aortic locations. Thefunctional significance of heart valve stiffening is minimal, but 25% of olderindividuals have flow murmurs.5. The aorta dilates and its walls thicken as medial walls calcify; with this loss ofelasticity, there is a secondary increase in systolic blood pressure. Thearteriosclerosis that is due to intimal disease further causes arterial walls tothicken, calcify, and lose their elasticity, thereby predisposing ageing vessels toocclude or rupture.6. The most important physiologic change is the delay in left ventricular filling,which declines 50% between the ages of 20 and 80 years. Cardiac filling becomesmore dependent on active filling late in diastole during atrial contraction. Thisphenomenon commonly is related to thickening and stiffening of the leftventricular wall.7. A reduced output of blood by the heart. Cardiac output is directly proportional tothe overall metabolic activity.At 10 years – 4lit/min/m2. After 20, it decreases by 1% per annum.At 80 years – 2.4 lit/min/m2. Resting cardiac output is decreased by 30%.Age-Related Cardiovascular Syndromes
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   52  Atherosclerosis, age-associated vascular stiffness predisposes to left ventricularstiffness, impaired diastolic filling, and the clinical syndrome of diastolic heart failure.The most common arrhythmia in older individuals is atrial fibrillation. Posturalhypotension is present in 20% of older individuals. Cardiovascular diseaseassociated with advancing age remains the most important single cause of deathworldwide, in old age.HEMATOPOIETIC SYSTEM105Hematopoietic activity differs considerably in young children from that of adults, and,in adults, from that of the elderly. Studies of the proliferative capacity of a colony-forming unit of granulocytes and macrophages (CFU-GM) in BM and blood fromdonors of different ages indicate that a functional decline in hematopoietic progenitor(stem cell precursor) cells begins at birth and continues throughout life.Hematological Profile of Some Older Individuals1. Decreased hemoglobin2. Decreased hematocrit3. Decreased red blood cell number4. Delayed onset of erythropoiesis after severe bleeding5. Decreased erythropoietic responses to erythropoietin administration6. Most of these changes are not experienced by centenarians.Longevity is thought to be associated with a well-preserved membrane structure, anda more viable RBC may contribute to a longer life span.MUSCULOSKELETAL SYSTEM106
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   53  With ageing, the balance between rates of bone formation and rates of bone resorptionis disturbed and the ensuing changes lead to a decrease in bone mass. After the age of40 years, formation rates remain constant whereas resorption rates increase. Bonemass and density decrease with age after reaching maximum in the 20s. In women,this loss may be about 1% per year until menopause, when it can increase to 2 to 3%per year. Men have more bone mass than women and lose bone mass at a similar rateof about 1% per year, the clinical effects in men are not seen until advanced age.Tendons and ligaments become less elastic with advancing age, contributing to ahigher incidence of rupture, especially of the Achilles tendon, in older individuals.Cartilage and ligaments of the ribs and spine are more likely to become calcified andless elastic.Joints:-In synovial or weight bearing joints, the calcified layers of articular cartilagebecome thinner. There is a proliferation of fibrous tissue at the articular marginsleading to well-defined lipping consisting of fibrocartilage, hyaline cartilage andfinally bone. Osteophytes are commonly found. Hypertrophic arthritis is believed tobe physiological in old age. The list of musculoskeletal disorders of the elderly isquite long and only an abbreviated one is presented here; one of these disorders,osteoarthritis, will be briefly compared with “normal” ageing changes.Muscle107: - Structural and functional changes in the ageing skeletal muscle include,1. Increased size, but decreased number of myocytes,2. Increased connective tissue matrix,3. Increased myocardial stiffness, Escherichia coli, Streptococcus pneumonia,Mycobacterium tuberculosis, Pseudomonas aeruginosa, Herpes virus1. Gastroenteritis, bronchitis, and influenza
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   54  2. Reappearance of latent viral infection3. Autoimmune diseases and inflammatory reactions as follows:Arthritis, Diabetes, Osteoporosis, Dementia, SLE.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   55  RENAL AND URINARY EXCRETORY SYSTEM1081. Kidney shrinks from 400gm in adult life to less than 300gm by age 90.2. Decrease in number of nephrons upto 50% between 40 and 70 years.3. Glomerular filtration rate falls from 140ml/min/1.73m2in mid-adult life by8ml/min 1.73m2 for each decade.4. Renal blood flow – reduced from 600ml.min in adult to 300ml/min at age 80.5. Increased permeability and sclerosis of glomerular basement with age leading todecreased surface area for filtration.6. The bladder tends to become more irritable with advancing age and may generateless power during contraction. Because of the delay in sodium excretion andorthostatic changes, nocturia is common; older individuals seem to produce moreurine at night than during the day. The most important bladder change may be theslight increase in residual bladder urine volume. Atrophy of vaginal and urethraltissues due to postmenopausal estrogen deprivation predisposes women to urinarytract infections.Age-Related Renal and Urinary Tract SyndromesAsymptomatic bacteriuria and urinary tract infections, Urinary incontinence, is moreprevalent in women, hypertension, Acidemia, Dehydration, Renal failure, Nephritis,Tuberculosis, Impaired drug excretion.Ageing-Related Changes in Electrolyte and Urea Excretion: Elderly persons aremore prone to develop hyponatremia and hypokalemia during diuretic therapy or dueto an inadequate diet. Blood urea may be reduced.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   56  Body composition: -In old individuals as compared to young, fat-free body weightand lean body mass (LBM) as well as body mineral are reduced, in contrast to bodyfat, which increases. Total body water is diminished with age. Extracellular waterremains unchanged, whereas intracellular water decreases.Prostate Gland: -With age, the outer zones of the prostate progressively atrophywhile the inner zones begin to grow again. Unlike any other organ, the prostate growsuntil death. Benign prostatic hyperplasia (BPH) and Prostate cancer are common inold age.REPRODUCTIVE SYSTEM109Males: - The primary manifestation of gonadal-axis ageing is progressive testosteronedeficiency produces less muscle strength, fewer viable sperms and decreased sexualdesire/climacteric 65 years of age. In addition, concentrations of Prolactin decreaseand of FSH increase reciprocally in older men.Female: - The total number of follicles in the mammalian ovary declinescontinuously with increasing age. With the declining number of growing ovarianfollicles in women approaching menopause, total ovarian volume declines as well.There are two main areas of attention for women in the reproductive ageing, ormenopausal, process. The first is the loss of fertility. Second is the increased risk forhealth problems and conditions that accompanies the transition into postmenopausal,Dyspareunia, cardiovascular diseases, bone density, osteoporosis.ENDOCRINE SYSTEM1101. Growth hormone levels fall with advancing age. These declines contribute to thedecreased muscle strength, thinning of bones and skin, and increased central fatassociated with ageing.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   57  2. Both night and day melatonin levels decrease in most elderly, probably due toalterations (e.g., axon swelling) of sympathetic innervations.3. The production rates and clearance rates of thyroxine, triiodothyronine, andcalcitonin seem to be constant with advancing age despite the increasedprevalence of thyroid disease in late life.4. There is an increase in parathyroid hormone levels, particularly in women, withadvancing age, perhaps in compensation for the age-related decline of the kidneysability to maintain normal levels of phosphorus and calcium in the blood.5. The adrenal glands maintain their ability to secrete cortisone with advancing age.Dehydroepiandrosterone declines 85 to 90% by the age of 70 years, however,perhaps contributing to impaired immune or cardiovascular function withadvancing age. Renin and aldosterone secretion rates decline progressively withadvancing age and do not contribute to the increased rates of hypertension withadvancing age.6. The insulin content of the elderly pancreas is increased, but the release of insulinin response to stimulation may be blunted with advancing age. Insulin resistancemay increase with advancing age, but glucagon secretion seems to be wellpreserved.7. The ovaries show dramatic declines in estrogen and progesterone as fibrosis andscarring occur. Menopause occurs at an average age of 51 years with subsequenthot flashes, accelerated bone loss, and atrophy of estrogen-sensitive tissues.8. Levels of testosterone decrease in some men beginning around 50 years, butdeclines do not seem to affect the potency of semen. Sexual function is relativelywell preserved, though with an increase in the refractory period and time toarousal and a loss of tissue turgor.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   58  Age-Related Endocrine SyndromesMenopause, Diabetes, Graves’ disease or toxic diffuse goiter and Hashimoto’s diseaseor chronic lymphocytic thyroiditis.NERVOUS SYSTEM 111Brain size decreases with advancing age; after the age of 60 years, its size declines by5 to 10%. The decrease in size is caused primarily by a decrease in the cerebralcortex. Novel adjustments to cell loss include the formation of new connectionsbetween remaining neurons. Ageing is associated with a progressive decline in thesynthesis of neurotransmitters and a decline in their corresponding receptors. A majorfunctional change is slower reaction times, which may be the result of a slower nerveconduction or transsynaptic speed.Ageing in the Central Nervous System Induces Structural and Biochemical ChangesResulting in Functional Consequences,Structural changes1. Regional selectivity2. Neuronal loss/gliosis3. Reduced dendrites and dendritic spines4. Synaptic susceptibility5. Vascular lesionsBiochemical changes1. Neurotransmitter imbalance2. Membrane alterations3. Metabolic disturbances4. Intra-intercellular degeneration
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   59  5. Cell adhesion alterations6. Neurotropic changesFunctional consequences1. Sensory and motor decrements2. Circadian (sleep) alterations and EEG changes3. Cognitive impairment4. Increased neurologic and psychiatric pathology5. Impaired homeostasisAge-Related Neurologic SyndromesAge-associated memory dysfunction is common and delirium may occur, especiallyduring illnesses. Sleep apnea seems to rise in prevalence with advancing age.Other changes with normal ageing include the following:1. Decreased extra- and intracellular water content of the brain (as of most otherorgans), while electrolyte distribution remains essentially unchanged.2. Regional decrease in protein content and synthesis, perhaps associated with slowturnover (to maintain steady state), increased oxidation of proteins and theirconsequent glycosylation, an increase in complexity of RNA molecules, anincrease (perhaps related to gliosis) or no change in DNA content, and anaccumulation of intraneuronal proteins (such as NFTs).3. Decreased lipid synthesis, primarily decreased synthesis of membranephospholipids due to increased variation in the structure of lipid substrates, ratherthan reduction of synthesizing enzyme activity or concentration of substrates;changes in membrane lipids would alter membrane fluidity and, in turn, nerveconduction and receptor binding.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   60  4. Circulatory changes related primarily to atherosclerosis and a decrease in cardiacoutput and characterized by a progressive reduction in cerebral blood flow and acorresponding decrease in oxygen uptake, glucose utilization, and, consequently,energy metabolism.Effects of ageing for three major functional areas of the nervous system: Motor function: gait and balance Rhythmicity of daily activity: wake/sleep Cognitive function: memoryDisruption of these functions can lead to neurologic (e.g., locomotor, as inParkinson’s disease) and mental (e.g., cognitive, as in dementia) deficits. Dementiasare characterized by an insidious, global, and persistent decline in cognitive functionfrom a previous higher level of activity often associated with emotional changes,neurologic deficits, and vascular disturbances.Reflexes: superficial reflexes become initially sluggish and commonly absent in oldage. Tendon reflexes may be difficult to elicit. Ankle jerk has been reported to thefirst and foremost reflex to be lost in old age.Sleep patterns change during growth and development as well as in old age (50). Inold age, major changes include1. Decrease in total sleep time (TST),2. Increase in length of slow wave (SW) stages 1 and 2 sleep,3. Decrease in length of SW stages 3 and 4 sleep,4. Essentially unchanged rapid eye movement (REM) sleep time,Psychological112
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   61  The elderly become irritable and less adaptable to surroundings. Change in socialbehavior emotional instability, loss of self-confidence, mental depression,hallucinations and paranoid and per security fears results in social isolation.Impaired memory, rigidity of outlook and dislike of change are important mentalchanges in aged.“It is better to say that, years wrinkle the skin but worry/doubt/anxiety/depression, i.e.stress wrinkle the soul.”SKIN113Perhaps no manifestation of ageing is as dramatic or readily obvious as that whichoccurs in the skin and its appendages. The development of either grey hair or facialand body wrinkles represents irrefutable evidence of the passage of time and ofprogressive ageing.Approximately two thirds of ageing individuals experience at least one skin problem,and about 40% have two underlying skin disorders.Thinning of the subcutaneous tissue begins in most people in their mid-40sindependent of the degree of sun exposure or protection from injury. The epidermisand dermis adhere less tightly, making the skin feel looser and increasing its tendencyto blister and to be subject to friction burns or pressure ulceration. This phenomenonalso leads to senile purpura those results from tears in small venules.Environmental exposures help promote the development of wrinkles by damageingthe subcutaneous tissues and the epidermis, especially the elastin fibers. In individualsolder than 65 years, healing takes about 50% longer compared with individuals intheir 30s; complete skin healing can take 5.5 weeks instead of 3.5 weeks.Ageing-Related Changes of Skin Appendages
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   62  Older individuals produce less sweat because sweat glands decrease in number or infunctional efficiency, a decrease that interferes further with thermoregulation. Thenumber of sebaceous glands remains constant with age, their size increases while thesebum output as well as wax production declines with age. The diminished sweat andoil production no doubt contribute to skin dryness and roughness in the elderly. Therate of linear nail growth decreases with ageing. Nail plates usually become thinner,more brittle, and fragile.Hair graying occurs because of a progressive loss of functional melanocytes from hairbulbs. With ageing, the decreased number of hair follicles in the scalp leads toincreased balding.The number of Pacini’s and Meissner’s corpuscles (end organs responsible for thesensation of pressure and light touch, respectively) decrease with age. This results indecreased sensation and predisposes the elderly to injury and decreased ability toperform fine maneuvers with the hands.EYE114The decline in visual acuity and contrast sensitivity with age may be the result ofalterations in the following optical and neural factors:1. Altered refraction of the light rays by the cornea and the lens2. Decline in accommodation3. Decreased light input due to constricted pupils (senile miosis)4. Decline in the density, number, and function of visual receptor cells,particularly in the fovea5. Ageing changes in central neural structures of the visual system.Major pathologiesCornea -“Against the rule” astigmatism
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   63  Lens -Cataract; - hardening and loss of elasticityRetina -Senile macular degeneration,Glaucoma -Open angle and closed angle types.EAR114Incidence of hearing disorders rapidly increases with ageing, afflicting nearly a thirdof people over 65 and one-half of those over 85 years. Hearing impairments are 20%more frequent in elderly men than women.1. External Ear: decline in number and activity of sebaceous and cerumen glands.2. Inner ear: degeneration in the lining of cochlea and labyrinth.3. Sensory: neural impairment, tinnitus, vertigo.The degeneration of neuraltransmission from the ear to the brain results in difficulty in identifying a voice orunderstanding a spoken message when there is background noise. Age-relatedhearing loss (ARHL) is called presbycusis.SMELL115The decrease in olfaction worsens with progressing age and may culminate in failureof smell detection by age 80 years and older; it is greater for some odors than others,and, overall, females score better than males.In the nasal cavity, ageing changes begin to occur at a relatively early adult age andsteadily progress with advancing age. They include loss of cilia from cells of the nasalmucosa, followed by loss of cells, and by slower replacement of lost cells and loss ofneurons in brain olfactory centers such as the olfactory bulb. Neuronal losses may besecondary to the loss of the sensory cells from the nasal mucosa (and hence, to loss ofsensory stimulation) or to cerebral degenerative changes (e.g., in Parkinson’s andAlzheimer’s diseases).TASTE115
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   64  With age, the ability to taste foodstuffs and other materials not only lessons overall,but also changes in relation to the various modalities of the taste.1. Threshold sensitivity to specific food stimuli and discriminatory ability to identifyflavors in a mixture decline with ageing.2. This decline may be ascribed to peripheral (e.g., loss of taste buds) and, possibly,central degeneration of neural centers of the gustatory system.PHARMACOLOGY116There are various physiologic changes that occur with ageing that may affect drugdisposition in the body.Pharmacokinetics is defined as the handling of a drug within the body, including itsabsorption, distribution, metabolism, and elimination.1. However several changes in the GI tract may affect the pattern of absorption.2. The distribution of medications within the body is dependent on whether the drugis lipid soluble or water-soluble and the extent of protein binding. Age-relatedchanges in body composition may significantly affect drug distribution. Withageing, lean body mass and total body water decreases, whereas fat contentincreases.3. The liver is the main site of metabolism or biotransformation of drugs. Old agecauses hepatic mass and blood flow to decrease, and consequently the relative bio-availability of the drugs increases.4. Renal elimination is considered the most significant pharmacokinetic change inthe elderly. Between the fourth and eighth decades of life, renal mass decreases onan average by 20%, and renal blood flow decreases by 10 mL/min per decadeafter age 30. Glomerular filtration rate, as expressed by the creatinine clearance(CrCl), also declines linearly with age beginning in the fourth decade.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   65  Medications to be Avoided in the Elderly1171. Anticholinergic: - Amitriptyline, Belladonna alkaloids, Chlorpheniramine,Dicyclomine, Diphenhydramine, Doxepin, Hydroxyzine, Hyoscyamine,Oxybutynin, Promethazine.2. Long-acting benzodiazepines: - Diazepam.3. Analgesics:-Indomethacin, Ketorolac, Meperidine, Propoxyphene4. Long-term use of stimulant laxatives:-Bisacodyl, Cascara sagrada5. Cardiac medications:-Amiodarone, Clonidine, Doxazosin, Nifedipine (short-acting), Digoxin at doses that exceed 0.125 mg/day, Nitrofurantoin, Cimetidine,Chlorpropamide.ANTI-AGEING MEDICINE118Anti-ageing medicine, also known as Life extension, experimental gerontology, andbiomedical gerontology, refers to attempts to slow down or reverse the processes ofageing to extend both the maximum and average lifespan. Some researchers in thisarea, and “life extensionists” or “longevists” (who wish to achieve longer lives forthemselves), believe that future breakthroughs in tissue rejuvenation with stem cells,molecular repair, and organ replacement (such as with artificial organs orxenotransplantations) will eventually enable humans to have indefinite lifespanthrough complete rejuvenation to a youthful condition.Contents
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   66  1. Current anti-ageing strategies and issues Diets and supplements Cosmetics and Surgery Hormone treatments2. Proposed strategies of life extension Nanotechnology Cloning and body part replacement Cryonics Theoretical combination strategies Genetic ModificationCurrent anti-ageing strategies and issuesDiets and supplements Much  life  extension  research  focuses  on  nutrition—diets  or  supplements—as  a means to extend lifespan, although few of these have been systematically tested for significant longevity effects. The many diets promoted by anti‐ageing advocates are often  contradictory.  Two  diets  with  different  approaches  and  some  support  from scientific research are the Paleolithic diet and Caloric restriction.  The  free  radical  theory  of  ageing  suggests  that  antioxidant  supplements,  such  as Vitamin C, Vitamin E, Q10, lipoic acid, Carnosine and N‐acetylcysteine, might extend human life[However, combined evidence from several clinical trials suggest that high dose  vitamin  E  and  beta  carotene  supplements  increase  mortality  rates.   Other substances proposed to extend lifespan include oxytocin, insulin, human chorionic 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   67  gonadotropin (hCG) and erythropoietin (EPO). Resveratrol is a sirtuin stimulant that appears to extend lifespan in simple model organisms such as nematodes and short‐lived fish.  Some supplements, including the minerals selenium or zinc have been reported to extend  the  lifespan  of  rats  and  mice,  though  none  has  been  proven  to  do  so  in humans, and significant toxic effects were observed.  Cosmetics and Surgery Cosmetic  interventions  such  as  skin  treatments  (for  example,  facials,  skin resurfacing, Botox, Argireline) and plastic surgery are widely used to mask the visible effects of ageing, although they do not actually affect lifespan. Hormone treatments The anti‐ageing industry offers several hormone therapies. Some of these have been criticized  for  possible  dangers  to  the  patient  and  a  lack  of  proven  effect.  For example,  the  American  Medical  Association  has  been  critical  of  some  anti‐ageing hormone therapies.  Proposed strategies of life extensionNanotechnology Future advances in nanomedicine could give rise to life extension through the repair of  many  processes  thought  to  be  responsible  for  ageing.  Raymond  Kurzweil,  a futurist  and  transhumanist,  believes  that  advanced  medical  nanorobotics  could completely remedy the effects of ageing by 2030.  Cloning and body part replacement Some life extensionists suggest that therapeutic cloning and stem cell research could one day provide a way to generate cells, body parts, or even entire bodies (generally 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   68  referred  to  as  reproductive  cloning)  that  would  be  genetically  identical  to  a prospective patient.  Cryonics For  cryonicists  (advocates  of  cryopreservation),  storing  the  body  at  low temperatures  after  death  may  provide  an  “ambulance”  into  a  future  in  which advanced medical technologies may allow resuscitation and repair. They speculate cryogenic  temperatures  will  minimise  changes  in  biological  tissue  for  many  years, giving the medical community ample time to cure all disease, rejuvenate the aged and repair any damage that is caused by the cryopreservation process. Theoretical combination strategies Another proposed life extension technology would combine existing and predicted future biochemical and genetic techniques. One such theoretical strategy proposes a cure for cancer, stem cell treatments, addition of new enzymes to the human body and moving mitochondrial DNA to the cellular nucleus. This proposal is said to lack scientific  evidence  and  has  been  called  pseudoscientific  because  its  proposed techniques are speculative.  Genetic Modification Gene therapy, in which artificial genes are integrated with an organism to replace mutated  or  otherwise  deficient  genes,  has  been  proposed  as  a  future  strategy  to prevent  ageing.  Targeting catalase  to  the  mitochondria  resulted  in  a  20%  lifespan increase  in  transgenic  mice,  and  improved  performance  in  AAV  therapeutically infected mice.  Figure 1. Percentage of functions at 70-80 years of age 100% at 20 years
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   69  Figure 2. Features and consequences of Normal Ageing119. 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   70     Table 7 Showing age related changesSL.NoOrgan/System Age-RelatedPhysiologicalChangeConsequences ofAge-RelatedPhysiologicalChangeConsequences of diseases,not age↑Body fat ↑Volume ofdistribution forsoluble drug.Obesity1 General↓Total bodywater↓Volume ofdistribution forwater-soluble drugsAnorexia↑Susceptibility toglareA.R.M.D.2 Eyes LensopacificationNeed for increasedillumination3 Ears ↓High –frequency acuityDifficultydiscriminatingwords if background
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   71  noise is present.Impaired glucosehomeostasis↑Glucose level inresponse to acuteillnessDiabetesmellitus↓Thyroxineclearance andproduction↑T dose required inhypothyroidismThyroiddysfunction↓ADH, ↓ Renin,and ↓aldosterone↓Na+, ↑K+↓Testosterone Impotence4 EndocrineSystem↓Vitamin Dabsorption andactivationOsteopenia Osteomalacia,fracture.5 RespiratorySystem↓Lung elasticityand ↑chest wallstiffnessVentilation/perfusion mismatch and ↓P02Dyspnea,Hypoxia.↓Arterialcompliance and↑systolic BP→LVHHypotensiveresponse, ↑HR,Volume depletion,or loss of arterialcontractionSyncope↓Β-adrenergicresponsiveness↓Cardiac output andHR response tostressHeart failure6 Cardiovascular System↓Baroreceptoresensitivity andSA nodeautomaticityImpaired bloodpressure response tostanding, volumedepletionHeart block↓Gastric acidity ↓Ca2+ absorption onempty stomachOsteoporosis,B12 deficiency↓HepaticfunctionDelayed metabolismof some drugsCirrhosisColonic motility constipation Fecalimpaction7 Gastrointestinal SystemAnorectalfunctionFecalincontinence↓Thymus↓T cell function False negative PPresponse8 Immunesystem ↑Autoantibodies Rheumatoidarthritis, SLE.Autoimmunedisease↓GFR Impaired excretionof some drugs↓Serumcreatinine
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   72  ↓UrineconcentrationDelayed response tosalt or fluidrestriction/ overload;nocturia↓↑Na+9 UrinarySystemProstateenlargement↑Residual urinevolumeUrinaryincontinence,Urinaryretention.10 ReproductiveSystemVaginal/urethralmucosal atrophyDyspareunia,bacteriuriaSymptomaticUTI↓Lean bodymass, MuscleFunctionalimpairment↓Bone density Osteopenia Hip fracture11 Musculoskeletal System↓Brain catecholsynthesisBenign senescentforgetfulnessDementia,delirium,Depression↓BraindopaminergicsynthesisStiffer gait Parkinson’sdisease↓Reflexes ↑Body sway Falls12 NervousSystem↓Stage 4 sleep Early wakening,insomniaSleep apneaTable 8. Showing some laboratory values in old age120Unchanged Decreased IncreasedHepatic function testsSerum bilirubinAST, ALT, GGTP.Serum albumin Alkaline phosphataseCoagulation tests HDL cholesterol (Women) Uric acidBiochemical testsSerum electrolytesTotal proteinCalciumPhosphorusSerum folateSerum B12 Total cholesterolHDL cholesterol ( men)Arterial blood testPH, Pco2Serum magnesium TriglyceridesRenal function testsSerum creatinineCreatinine clearance Plasma TSH (?)Thyroid function tests Plasma T3 (?) Plasma glucose tolerance
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   73  testsPlasma T4 White blood count Fasting blood sugar (may bewithin normal range)Complete blood countHematocritHemoglobinRed blood cellsPlateletsPostprandial blood sugar Note: The sign (?) indicates that changes in values with ageing may show greatindividual variability.Abbreviations: AST, aspartate aminotransferase; ALT, alanine aminotransferase;GGTP,g glutamyltransferase; HDL, high-density lipoprotein; PO2, partial pressure ofoxygen; PCO2, partial pressure of carbon dioxide; T3, triiodothyronine; T4,thyroxine; TSH, thyroid-stimulating hormone.      Table 9. Functional changes in old age121SI.NO.FUNCTION TYPE OFCHANGESI.NO.FUNCTION TYPE OFCHANGE1 Generalworkingcapacity- 30 Capillary blood flow -2 Reproductivecapacity- 31 Capillary resistance +3 Homeostaticregulation- 32 Cerebral blood flow -4 Sleep - 33 Renal blood flow -5 Total bodywater- 34 GFR -6 Antibodyformingcapacity- 35 Renal glucosereabsorption7 Cholesterol + 36 Nitrogen excretion -
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   74  level8 Collagencontents intissues+ 37 Urinary 17-ketosteroids-9 Heart function - 38 Urinary estrogens -10 Blood volume 0 39 Urinary androgens -11 Fat depositionin heart+ 40 Urinaryadrenocorticoids+12 RBC number ofHB%0 41 Renal function -13 Total plasmaprotein0 42 Total lung capacity -14 Plasma albumin 0 43 Residual capacity +15 Plasma globulin + 44 Vital capacity -16 Fibrinogen 0 45 Maximum ventilationcapacity-17 Bold urea andnon-proteinnitrogen+ 46 Total volume -18 Plasmaelectrolytes0 47 Maximum O2 uptake -19 Plasma PH 0 48 O2 diffusion capacity -20 Blood lactateafter exercise+ 49 BMR -21 Blood vitamins:A, Riboflavin,Thiamine0 50 Muscular strength -22 Blood vitamins:B12 andAscorbic acid- 51 Collagen cross linkage +23 Resting cardiacoutput- 52 Solubility of collagen -24 Stroke volume - 53 Calcium in muscle +25 Systolicpressure+ 54 Gastric acidity -26 Diastolicpressure- 55 Accommodation ofeye+27 Systolic time + 56 Nerve conductionvelocity-28 Circulationtime+ 57 Synaptic delay +29 Correlation ofheart beat with- 58 Reaction time +
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   75  heavy work Note: - 0 No change, - Decrease in activity, + Increase in activity.Table 10. Showing Comparison of specific activities of enzymes in tissues of adultand old mammals122 TISSUESSI.NO. ENZYMESLiver Brain Heart Kidney Prostate1 Acetyl cholinesterase   ‐  ‐     2 Acid phosphatase ‐      0   3 Adenylcyclase          4 Alanine aminotransferase ‐        ‐ 5 Aldolase         ++ 6 Alkaline phosphatase ‐      ‐  ‐ 7 Arginase 0      0   8 Cathepsin +      +   9 Cytochrome oxidase 0    0  0  ‐ 10 Glucose-6-phosphatase ‐         11 Glucose-6P-dehydrogenese         + 12 Glucokinase +      ‐   13 Glutamic aciddecarboxylase  0       14 Glutamine synthetase 0         15 Hexokinase         0 16 Lactate dehydrogenase 0  ‐  ‐  ‐  + 17 Lysozyme       +++   18 Malate dehydrogenase(cytoplasmic)+         19 Malate dehydrogenase(mitochondrial)+         20 Pyrophosphatase       +   21 Succinate dehydrogenase 0    0  ‐   22 Tryptophan pyrolase 0         23 Tyrosine aminotransferase ‐          Note: - 0, No difference; -, decrease in old age; +, increase in old age.  
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   76  JANUSANDHIGATVATAINTRODUCTION:Jara is the stage of the life where, Vata is in the dominant state and Rasadi saptadhatuare in deprived state. This potent combination is responsible for the aged people moreprone to Vatavikaras; among the Vatavikaras Sandhigatvata is the commonest one,especially Janusandhigatvata.DERIVITIONJanusandhigatavata is a compound word with 4 words combined. Janu, Sandhi, Gata,Vata.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   77  Janu Vyutapathi123– The word Sandhi is derived from the root “Jan” with suffix “junn”eÉlÉ +gÉÑhÉ eÉÉlÉÑNirukti – “EÂeÉ…ûrÉÉåqÉïkrÉpÉÉaÉå”Janu refers to the joint lying between Uru and Jangha ie. The Knee124.Sandhi  Vyutapathi – The word Sandhi is derived from the root “Dha” when prefixed by“sam” and suffixed by “ki” gives rise to the word Sandhi125.xÉqÉç + kÉÉ + ÌMü xÉÎlkÉNirukti – xÉÇrÉÉåaÉå, AÎxjɲrÉxÉÇrÉÉåaÉxjÉÉlÉå, xÉÇÍkÉlÉÉïqÉ xÉÇrÉÉåaÉÈSandhi means connection, combination, union with a conjugation, transition from oneto another126.In general the term sandhi means the junction between two things. In Shareera theterm sandhi denotes the junction between two bones.Sushruta Samhita mentions that there are innumerable junctions between peshi, snayu,sira, asthi etc. Here the description of sandhi refers to asthisandhi. Acharya Dalhanasupports the views of Sushruta Samhita and says sandhi means asthyashrita sandhi127.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   78  Gata Vyutapathi - The term Gata is derived from the root “Gam” with suffix“ktha”128.aÉqÉ + £ü aÉiÉ:Nirukti- mÉëÉmiÉå, rÉÉiÉå, sÉokÉå, mÉÌiÉiÉå, xÉqÉÉmiÉå cÉ |It means gone to, arrived at, situated in, directed to, come to, approached, arrived at,being in, Situated in, From above various meaning it can be revealed that the word“Gata” means the site. Hence in case of Sandhigatavata, it denotes the site in whichprovoked Vata is situated129.Vata Vyutapathi - The term Vata is derived from the root “va” with suffix‘ktha’130uÉÉ + £ü uÉÉiÉ:Nirukti- xmÉzÉïqÉɧÉÌuÉzÉåwÉaÉÑhÉMåü pÉÔiÉpÉåSå, mÉuÉlÉå, SåWûxjÉå kÉÉiÉÑpÉåSå ||- Wind, air, one of the humors of the body131.It means to blow, to go, to move, to smell, to strike, to enlighten.Thus Janusandhigatvata means aggravated Vata located in Janusandhi.Paryaya of Sandhigata vata132.1. Sandhivata2. Sandhigatanila3. Khudavata
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   79  4. Jeerna vataSHAREERA VIVECHANA Anatomy and Physiology of SandhiIn Ayurvedic classics regarding the structures which are responsible for the formationand function of Janusandhi as such no direct reference is available. Thus, here anattempt has been made to describe some probable structures and factors responsiblefor formation and function of Sandhi.According to Sushruta Samhita, Sandhi is one of the five types of Marma. (Su. Sh.6/3). The Janu, Kurpara, Gulpha, Manibandha are considered as Sandhi Marma. Outof these, Janu and Kurpara belong to Vaikalyakara group of Marma. Asthi Sandhi isone of the components of Madhyamarogamarga (Ca. Su.11/48). Janu sandhi isconsidered under Chala and Kora sandhi. ( Su.Sha.5/25,5/27). Explanation of JanuKapala is available in Sushruta and Charaka Samhita. Charaka Samhita whileexplaining the asthisankya mentioned that,²å eÉÉlÉÑlÉÏ, ²å eÉÉlÉÑMümÉÉÍsÉMåü, ²ÉuÉÔÂlÉsÉMüÉæ, cÉiuÉÉËU eÉ…ûrÉÉåÈ| (cÉ.zÉÉ.7/6.)Peshi: -Peshi is nothing but Mamsakhanda. Shira, Snayu, Asthi and Sandhi arecovered and supported by Peshies133.Snayu: -Sharangadhara says that Snayu is binding material of Mamsa, Asthi andMeda. Human body is tightened at the Sandhi by a large number of Snayu enable tobear weight134.Kandara: - Functions of kandara are Prasarana aakunchan of body135.Shleshmadharakala: - Sushruta Samhita mentioned that the fourth kala issleshmadhara kala which is situated in every sandhi and executes the function
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   80  lubrication for movement. He compares it to a wheel functioning normally onlubrication. All the sandhis function normally in the presence of sleshmadhara kala,and protect it from damage136.Siras: - Siras supply the nutrient materials to the connected dependent parts. Thedivided branches of Siras perform the functions like upasnehana (nutrition),Akunchana (Flexion), Prasarana (Extension) 137. Siras are cause for sandhibandhan138.Vata: - In this context the vata referred to “Vyana” vata. Vyana vata is one amongfive varieties of vata, which resides in hridaya and controls most of the motorfunctions. It means Vyana Vata is responsible for all the movements of Sandhi likeAkunchana Prasarana etc139.........urÉÉlÉ xÉuÉÉï…ûxÉÎlkÉaÉ | (aÉrÉSÉxÉ on xÉÑ.ÌlÉ.1/13.)Gayadas in his commentary on Sushruta Samhita quoted the opinions of othercontexts that though Vyana vata resides all over the body but it is mainly situated inthe sandhi140.Kapha: - Sushruta Samhita states that shleshaka kapha holds and lubricates theSandhi to perform the movements in the normal directions. (Su.Su. 21/14).Mamsa: - Lepana is the Main function of Mamsa Dhatu, so it covers the Sandhi.Mamsa kshaya causes Sandhishula. (A.H. Su. 12/18).Meda: - The function of Meda dhatu is Snehana. Sandhis are upadhatu of medas. Itprovides nutrition to sandhi. Medakshaya causes Sandhishunyata.Asthi: - Asthi is the prime seat of Vata and principal structure of Sandhi. AsthiKshaya causes sandhi shaithilya.Majja: - The function of Majja is to fill the Asthis. Majja Kshaya makes the personafflicted by Vatarogas.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   81  Oja: - Oja is the Sara of all Dhatus and its Kshya causes Sandhivishlesha.Classification of Sandhigatavata:No reference is available of classification of Sandhigatvata. As Sandhigatvata is aVatavyadhi, it mainly occurs due to Prakopa of Vata so it can be classified in 2 typesas below.1. Dhatukshyajanya2. AvaranjanyaNIDANAAyurvedic literature does not reveal the special etiological factor forJanusandhigatavata however; the aggravative factors for vata can be adopted for it,which can be producing Janusandhigatavata, these are as follows141.1. Aharaja :- Ruksha - Laghu – Vishthambhi - Sheeta – Katu – Tikta - KashayaAnnasevena, Sheetapana, Adhyasana, Viruddha – Asatmya – Pramita – MithyaAhara etc.2. Viharaja :- Ati Vata – Atapa sevana, Ati Plavana, - Vyayama – Vyavaya –Chesta, Vegavidharana, Ratrijagarana, Divaswapa, Marmaghata, Abhighata etc.3. Manasaja :- Chinta, Krodha, Shoka, Bhaya etc.4. Kalaja :- Abhra (cloudy season), Aparahna (evening), Aparatra (end of night),Sheetakala (winter), Varsha (rainy season) etc.SAMPRAPTISandhigatavata has no specific Samprapti as per the texts available. It is classifiedunder the heading of the Vata Vyadhi.Charaka Samhita142has mentioned that, due to nidana Sevana Vata aggravates andthis aggravated Vata gets accumulated in Rikta Srotas and gives rise to variousgeneralized and localized diseases.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   82  The above Samprapti explained is the generalized Samprapti of Sandhigata vatawhich could manifest in any sandhi. But in this study only JarajanyaJanusandhigatvata has been considered, therefore a slightly site specific Sampraptihas been explained in the verses below.Dhatu kshaya janya SandhigatavataAshtanga hrudaya143explained that, dhatu kshaya leads to vata kopa and the vatagets settled in the Rikta srotasas causing the Sandhigatvata.In Jara avastha due to dhatukshaya aggravation of vata in the body. This aggravatedvata circulating in the whole body in searching of suitable place for Sthanasanshraya.Now if “Rikta Srotas” in any part of the body i.e., enumerated by AcharyaChakrapani, as ‘Tuchani’ or “snehadigunashoonya” is found then in such a site thevata dosha takes sthana samshraya causing the disease related to that part of the body.In this context, Rikta Srotas (snehadigunashoonya) is ‘Janusandhi’ due to Shleshakakapha kshaya. Thus aggravated Vata in Janusandhi undergo doshadushyaSammurcchana resulting in Janusandhigatvata.POORVA ROOPACharaka Samhita has quoted that Avyakta Lakshanas of Vata Vyadhi are to be takenas its Purvarupa. Commentator Chakrapani explains the term Avyakta as thesymptoms which are not manifested clearly.ROOPA: Roopa of Janusandhigatvata according to various classical texts istabulated below,Table 11. Showing Roopa of Janusandhigatvata according to various classicaltexts144, 145,146,147,148,149,150.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   83  1. Shoola in SandhigatavataCharaka Samhita mentions nature of pain as, “Prasarana - akunchanayopravraticha Vedana”i.e., pain experienced on flexion and extension. AshtangaSangraha and Ashtanga Hrudaya have similar opinion. Sushruta Samhita andMadhavakara mention the term “Shoola” alone without mentioning the nature of thepain.2. Sandhi ShothaSN  SYMPTOMS  C.S  Su.S.  A.S.  A.H  M.NI  Bh.Pr.  Y.R 1  Sandhi Shoola    +  ‐  ‐  +  +  + 2  Sandhi Shotha  +  +  +  +  ‐  +  + 3  Vatapurna  Druti Sparsha +  ‐  +  +  ‐  ‐  ‐ 4  Prasarana  akunchanayo pravraticha Vedana +  ‐  +  +  ‐  ‐  ‐ 5  Hanti sandhi  ‐  +  ‐  ‐  +  +  + 6  Atopa  ‐  ‐  ‐  ‐  +  ‐  ‐ 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   84  Charaka Samhita, Ashtanga Sangraha and Ashtanga Hrudaya defines the nature ofShotha as “Vatapurna Druti Sparsha” ie. A bag filled with air. Sushruta Samhita hasonly used the term Shotha without mentioning about its nature.3. Hanti SandhiSushruta Samhita describes the features of Sandhigata vata as “hanti sandhi”commentary to this feature is given by Acharya Dalhana as “Akunchanaprasaranayoh abhava” and Gayadasa as “prasaranakunchanayor asamarthya”.This means that individual is unable to flex or extend the affected joint. InMadhukosha Commentary, Commentator Vijayarakshita has given two meanings ofHanti Sandhigata. One is Sandhivislesha and another is Sthambha.4. AtopaThis feature is mentioned by Madhavakara.Vijayarakshita explain atopa as“gudaguda shabda.”UPASHAYA ANUPASHAYAUpashaya: - All drugs, diet and regimen which give relief in Sandhigatavata may betaken as Upashaya. For example Rasna, bala, ushna ahara, abhyanga, swedana, etc.Anupashaya: - All drugs, diet and regimen which exaggerate the disease are taken asAnupashaya for that disease. Also hetus of disease can also be taken as Anupashaya.SADHYASADHYATAIn old age Janusandhigatvata is Yapya.SAPEKSHANIDANA151
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   85  Though diseases differ from one another in several respects, but sometimes fewlakshanas of two or more diseases may overlap. This may put a physician in doubt; toovercome this one needs to go for differential diagnosis or sapekshanidana.The diseases which closely resemble Janusandhigatavata and manifest in Janu sandhiare,1. Amavata2. Vatarakta3. Sandhi bhagna4. Krostuka sheershaTable 12. Showing Sapeksha Nidana of JanusandhigatavataSandhigatavata Amavata Vatarakta KrostukasheershaSandhibhagnaNidana Vata parkopakaahara viharaAmotpadakavatakarakaVataprakopakaraktapradushakaVataprakopakaraktadushakaHistory oftraumaPurvaroopa- - Asweda oratisweda,vaivarnyapidaka,sandhisulaShula Prasaranakunchana sulaVrischikadamshavatshulaTeevra ruja Teevra ruja Teevra rujaShotha Vatapurnadrutivata sparshaShotha - Shotharesemblesjackles headDifficultyor Inabilityto flex orextend withshothaAtopa Present - - - May bepresentSarvadaihikalakshana- Jwara,alasya,aruchi,angamardaJwarakandu- -Upashaya Snehana Rukshasweda- - -
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   86  CHIKITSAThe event involving the utilization of efforts by physician, medicament, attendant andpatient to abolish disequilibrium among the dhatus and bring about equilibriumamong them is known as chikitsa.Chikitsa is mentioned as “Vighatana of Samprapti”. Sandhigatavata is a Vatikadisease, mainly occurs due to Dhatukshya or Avarana, so general treatment ofVatavyadhi can be adopted, keeping an eye on its etiology, common treatment likeSnehana, Svedana, Mrudu Samshodhana, Basti and Vatahara Aushadha, Ahara andVihara may also be applicable in Sandhigatavata152.The specific line of treatment of Sandhigatvata is explained by Sushruta Samhita asSnehana, Upanaha, Agnikarma, Bandhana, and Mardana. (Su. Chi. 4/8)Dalhana enumerates that these treatments have to be continued for a long time ie,“chirakala” for the word “atandrita” of Sushruta Samhita. The chikitsa mentionedby Sushruta Samhita is adopted by Ashtanga Sangraha, Ashtanga hrudaya,Chakrapanidatta, Bhavamishra, Bhaishajya Ratnavali, Yogaratnakara.Table 13. Showing the Chikitsa according to Different Acharyas153,154,155,156,157,158,159.SI.NO. CHIKITSA S.S. A.S. A.H. C.D. Y.R. B.P. B.R.1 Snehana + - + + + + +2 Abhyanga - + - - - - -3 Mardana + + - + + - +4 Upanahasweda + + + + + + +
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   87  5 Bandhana + + - + - - +6 Agnikarma + + + + - + +Table 14. Showing shamanoushadhi in Sandhigata Vata160,161,162.SI.NO. YOGA SI.NO. YOGA1 Tagara mula kalka with takra 15 Shadasheeti guggulu2 Indravaruni mula and pippali withguda16 Phala trikadi sneha3 Alambushadya choorna 17 Dashamula sidda majjasneha4 Abhadi choorna 18 Majja sneha5 Maharasnadi kwatha 19 Panchatikta guggulu gritha6 Rasna panchaka kwatha 20 Prasarini taila7 Ajamodadi vati 21 Trishate prasarini taila8 Adityapaka guggulu 22 Ekadasha tikta prasarinitaila9 Trayodashanga guggulu 23 Brihat prasarini taila10 Yogaraja guggulu 24 Vishnu taila11 Yogaraja guggulu Brihat 25 Siddartha taila12 Simhanada guggulu 26 Nakula taila13 Panchanana rasa louha 27 Saindhavadya taila14 Vatarakshasa rasa 28 Brihat saindavadya tailaPATHYA – APATHYAThe Specific pathya and apathya of Sandhigatvata are not mentioned. But being as aVatavyadhi, the list of Pathya-Apathya of Sandhigatvata is as given below.Table 15. Showing Pathya-Apathya of SandhigatvataSL.NO PATHYA APATHYAA. AHARA
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   88  1. Rasa Madhura, Amla, Lavana Katu, Tikta, Kashaya2. ShukhadhanyaNaveena Godhuma,Samvatsaroshitashali,Shastika shali, RaktashaliTaruna Dhanya, Kangu,Neevara, Shyamaka andChanaka3.Shimbi dhanyaNaveena taila, NaveenaMasha, KulatthaRajamasha, Nishpava4.ShakaPatola, Shigru, Vartaka,LashunaKumuda, Kamalanala,Palakya, Udumbara etc.5.Phala VargaDraksha, Parushaka,Pakva, Amra, Jambeera,Dadima, Pakva LataphalaJambu, Udumbara,Kramuka, Tinduka6. Mamsa VargaUstra, Go, Varaha,Mahisha, Hamsa, Bheka,Nakula, Chataka,Kukkuta, Tithira, KurmaTimingila, RohitaShushka mamsa Kapota,Paravata7.JalavargaUshna jala, Shrita Sheetajala, Narikela jalaNadee jala, Sheetambu,Tadagajala8.KsheeraGo, Aja, Dadhi, Gritha,Kilata, KurchiktaGardabha9. Mutra Gomutra Ajamutram10. Madya Dhanyamla, Sura Navamadya, Atimadyapana11. Sneha Tila, Gritha, Vasa, Majja --B. VIHARA Bhooshayya, Snana,Samvahana etc.Chinta, Jagarana, Shrama,Vyavaya, Vyayama,Chankramana, HastiAshwayana, andVegadharanaKNEE OSTEOARTHRITISIntroduction:Advancing age in an adult is associated with several degenerative changes in thebody. Osteoarthritis is the most common form of degenerative joint disorder. It isranked one among top few diseases branded by WHO as ‘Global disease burden’.80% of old age people have radiological evidence of O.A., though 25-30% is
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   89  symptomatic. Knee Osteoarthritis is the leading cause of disability in developedcountries.Derivation163The word osteoarthritis means –1. Osteo – The word ‘Osteo’ comes from the Greek word ‘Osteon’ means bone.2. Arthritis – The prefix ‘Arth’ means joint. The suffix ‘itis’ is defined asinflammation.Hence, arthritis means inflammation of joint. So osteoarthritis can be defined of asinflammation of the bony part of the joints.Definitions1641. A form of arthritis, affecting mainly older people, caused by chronic degenerationof the cartilage and synovial membrane of the joints, leading to pain and stiffness.2. The degenerative change of a joint, which makes it less able to withstand stressesand strains, causing pain and change to the shape of the joint.Synonyms1651. Gon arthrosis.2. Degenerative arthritis3. Hypertrophic arthritis,4. Age-related arthritis
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   90  KNEE JOINT166The knee is the largest and most complex joint of the body. The complexity is theresult of fusion of three joints in one. It is formed by fusion of the lateral femorotibial,medial femorotibial and femoropatellar joints.TypeIt is compound synovial joint, incorporating two condylar joints between the condylesof the femur and tibia and one saddle joint between the femur and the patella.Articular surfacesThe knee joint is formed by: 1) the condyles of the femur; 2) the condyles of the tibia;and 3) the patella. The femoral condyles articulate with the tibial condyles below andbehind and with the patella in front.LigamentsThe knee joints supported by a number of ligaments that are mentioned below. Fibrous (articular) capsule Ligamentum patellae Tibial collateral (medial) ligament Fibular collateral ligament Oblique popliteal ligament Arcuate popliteal ligament Menisci (semilunar cartilages) Transverse ligament Synovial membrane
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   91  Bursae around the kneeAs many as 13 bursae have been described around the knee; 4 anterior; 4 lateral and 5medial. Anterior Subcutaneous prepatellar bursa Subcutaneous infrapatellar bursa Deep infrapatellar bursa Suprapatellar bursa Lateral A bursa deep to the lateral head of the gastronemius A bursa between the fibular collateral ligament and the biceps femoris A bursa between the fibular collateral ligament and the tendon of the popliteus A bursa between the tendon of the popliteus and the lateral condyle of the tibia Medial A bursa deep to the medial head of the gastronemius The ansarine bursa A bursa deep to the tibial collateral ligament A bursa deep to the semimembranous Occasionaly bursa is present between the tendons of the semimembranous andthe semitendinousRelations of knee joint Anteriorly Anterior bursae Ligamentum patellae Patellar plexus of nerves
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   92   Posteriorly Popliteal vessels Tibial nerve Plantaris Common peroneal nerve Gastrocnemius Semitendinosus Gracilis Popliteus Medially Sartorius Gracilis Semitendinosus Great saphenous nerve and vessels Semimembranosus Inferior medial genicular vessels and nerveSynovial fluid It is found in the cavities of synovial joints. The main function is lubrication andalso nourishment of articular cartilage. The physical nature of this is a clear orpale yellow, viscous fluid of slightly alkaline pH at rest. This nature varies widelybetween different joints and spaces.Composition : Protein0.9 mgm /mlHyluronic acid
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   93  Monocytes, lymphocytesMacrophages, Synovial cellsOccasional polymorphon nuclear leucocytesAmorphous, met achromatic particles and fragments of cells and fibrous tissuesometimes found are result of slow wear and tear of joint surfaces.Blood supplyThe chief sources are: Five genicular branches of the popliteal artery The descending genicular branch of the femoral artery The descending branch of the lateral circumflex femoral artery Two recurrent branches of the anterior tibial artery The circumflex fibular branch of the posterior tibial arteryNerve supply Femoral nerve Sciatic nerve Obturator nerveMovements at the knee jointThe knee permits flexion and extension about a virtual transverse axis, as well as a slight  medial  and  lateral  rotation  about  the  axis  of  the  lower  leg  in  the  flexed position.  
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   94  Table 16. Showing Movements at the knee jointSl.No. MaximumMovementPrinciple muscle Accessorymuscle1. Flexion Biceps femorisSemitendinosusSemimembranousGracilisSartoriusPopliteusGastrocnemius2. Extension Quadriceps femoris Tensor fasciae latae3. Medial rotation offlexed legPopliteusSemitendinosusSemimembranousSartoriusGracilis4. Lateral rotation offlexed legBiceps femorisRISK FACTORS OF KNEE O.A167.Several risk factors have been defined for O. A. by proper epidemiological studies.All of them are important factors and it is particularly significant to recognize thosethat are remediable to meet growing frequency of this disease in population. Here themajor risk factors of O. A. have been described as under.1. Age & Sex:-2. Genetic Susceptibility  3. Racial Differences  4. Development Deformities5. Trauma:-6. Obesity: -7. Repetitive joint use:-8. Estrogen Deficiency:-
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   95  9. Muscle Weakness: ‐   1. Age & Sex:-Age is the most dominant risk factor for Knee O.A. Radiographic evidence of knee O.A. and especially symptomatic knee O. A. is more common in women than in men.(29.7% vs. 10.9%, respectively). Knee Osteoarthritis may be regarded as a reward oflongevity.2. Genetic Susceptibility  Many studies have demonstrated that genetic factors influence the incidence of OA. However  more  recent  studies  on  other  matrix  components  such  as  aggrecan  or vitamin D receptor have revealed no significant genetic abnormality in people with primary OA. 3. Racial Differences  The prevalence of Knee O.A. is common in South African Blacks than in Whites ofthe same population.4. Development DeformitiesAnatomical anomalies of knee and hip that are present at birth or that develop duringchildhood may result in accelerated or premature OA. These include genuvarum,genuvalgum, leg calve Perth’s disease, congenital hip sublaxation.5. Trauma:-Major trauma is important risk factor for O. A. anterior cruciate ligamentinsufficiency or meniscus damages [and meniscectomy] may lead to knee O. A.Although damages to the articular cartilage may occur at the time of injury or
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   96  subsequently, with use of the affected joint, even normal cartilage will degenerate ifthe joint is unstable.6. Obesity: -There is a strong link between obesity and osteoarthritis of the knee and, to alesser extent, of the hip and fingers. As the prevalence of knee and hand osteoarthritisis higher in women it is not yet known whether the association is due to excessmechanical loading or unknown metabolic factors or, more likely, a combination ofboth.7. Occupation:Occupations requiring repetitive use of particular joint groups, lead to a highincidence of osteoarthritis in those joints. Miners and workers in other occupationsthat involve regular knee bending develop knee osteoarthritis.8. Estrogen Deficiency:-Incidence of O.A. is greater in older women than in older man. But the highlyaccelerated rate of O.A. [hip and knee] in women after the age of 50 yrs suggest thatpostmenopausal estrogen deficiency increase the risk of O.A.9. Muscle Weakness: ‐  In knee O.A. there exist a direct relationship between the weakness of quadricepsmuscle and severity of symptoms. Disability in those with knee O.A. is more stronglyassociated with quadriceps muscle weakness than with either joint pain orradiographic severity of the disease.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   97  PATHOGENESIS: Osteoarthritis is a metabolically active condition. Repair andsynthesis counteract the destructive processes until the repair processes overwhelmedlate in the disease course.1. Initial Changes:Chondrocytes in hyaline cartilage are responsible for maintaining the extracellularmatrix by balancing catabolic and anabolic functions. Synthesis of the matrix issynchronized with their degradation by proteolytic enzymes. Two factors maycontribute to the initiation of Osteoarthritis.a. A region of highly focal mechanical stress.b. An intrinsic defect in the cartilage matrix, as single-base mutation in the type 2procollagen gene (COL2A1) renders collagen fibrils prone to fragmentation andthus early Osteoarthritis.2. Progression:a. Early: Synthesis of proteoglycans and collagen is increased with some degree ofdegradation.b. Late: As Osteoarthritis develops further, proteoglycans synthesis decreases,resulting in a net loss of matrix protein. Structural changes in the proteoglycansmolecules include degradation of the core protein, reduction in the size of theproteoglycans aggregates, and reduction in the hyaluronic acid content. In
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   98  addition, synthesis of different collagen gene products, which alter the collagenfiber network, characterizes this late phase.3. Factors involved:a. Proteolytic enzymes: Chondrocytes secrete degradative enzymes (e.g.metalloproteinases). Metalloproteinase activity is controlled by inhibitors andactivators. In Osteoarthritis, the production of metalloproteinases exceeds theamount of so called tissue inhibitors of metalloproteinase (TIMPs).b. Cytokines and inflammatory mediators:1. Catabolic: IL-1, IL-6, and IL-8; TNF; nitric oxide; and prostaglandin E2 ( PG E2).IL-1 stimulates the production of proteases while suppressing the synthesis ofproteoglycans and type 2 collagen. In addition, IL-1 induces chondrocytesproduction of other detrimental cytokines as well as nitric oxide and PG E2.2. Anabolic: growth factors such as TGF- and insulin like growth factor (IGF-1).TGF- antagonizes the action of IL-1, and IGF-1 is the major regulator ofproteoglycan synthesis.PATHOLOGY:1. Cartilage changes:a. Early in Osteoarthritis, cartilage changes in colour from blue to yellow due to lossof proteoglycan.b. Localized areas of softening are earliest pathologic changes in Osteoarthritis.c. Superficial chipping and flaking of cartilage signifies more advanced disease.d. Vertical fibrillations in the cartilage indicate further progression.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   99  e. If the healing forces are overwhelmed by destructive forces, confluent erosionseventually progress to full-thickness cartilage loss.2. Bone changes:a. New bone formation can occur under the cartilage (seen as eburnation on aradiograph) or at the joint margin (seen as osteophytic spurs on a radiograph).b. Subchondral cysts large pseudocystic areas can form in the juxtra-articular bonedue to transmission of increased mechanical forces to bone; presumably, thesecysts fail to heal because of impaired perfusion from subchondral microfractures.CLASSIFICATION OF OSTEOARTHRITISPrimary Osteoarthritis:1. Local: Cervical spine, Hip, First carpometacarpal joint, Distal interphalangealjoints, Lumber spine, Knee, First metatarsophalangeal joint, Proximalinterphalangeal joints.2. Multiple sites: Heberden’s nodes, generalized osteoarthritis, “Erosive”osteoarthritis, Diffuse idiopathic skeletal hyperostosis.Secondary Osteoarthritis:a. Congenital (e.g. hip dysplasia)b. Deposition disease: Ochronosis, Wilson’s disease, hemochromatosis, Gout,calcium pyrophosphate deposition disease.                                                                                      c. Neuropathic joint ( e.g. diabetes mellitus, syphilis),                                                  d. Endocrine/metabolic (e.g. Acromegaly),  
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   100  e. Osteonecrosis ( especially hips, knees),                                                                                               f. Infection (T.B.),                                                                                                                     g. Inflammation ( rheumatoid arthritis) Knee: 1) Medial Compartment2) Lateral Compartment3) Pattellofemoral CompartmentTable 17. Showing signs and symptoms of O.ASYMPTOMS SIGN1. Joint pain2. Joint stiffness3. Instability1. Crepitus2. Restricted movements3. Tenderness4. Joint enlargement5. Muscle weakness6. Warmth.SYMPTOMS:1. Joint pain:The major symptom which put the patient of O.A in trouble is pain. The pain of O.A.is most often described as a deep ache, accompanied frequently by joint stiffness afterperiods of inactivity (on arising in the morning or after sitting). In the early stages ofthe disease, pain is commonly relieved by rest. With more severe disease, pain may bepersistent, interfering with normal function and preventing sleep, even with medicalmanagement.2. Joint Stiffness:
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   101  Joint stiffness is common but it is much less prominent than in other conditions likerheumatoid arthritis. Characteristically the affected joints get during a period ofinactivity like sitting and it takes a minute or two to loosen up and get going.Normally it is of less than 15 min. duration.3. Instability:Many patients complain that they feel unsteady and are afraid to go out because theaffected joint has ‘given way’ on them. This usually reflects arthrogenous inhibitionof muscle contraction or muscle wasting.SIGNS:1. Crepitus:It is a creaking sound as the joint is moved. It is characteristics of O.A. it may presentas the soft crepitus of fibrillated cartilage, as in the Pattellofemoral joint or the otherharder sharp crepitus of joints in which articular cartilage has been lost so thatadjacent bony surface rub against each other with movement. It is typical of O.A ofthe thumb base & knee.2. Restricted Movements:Movement of the joints may be restricted by pain, muscle spasm, or by mechanicalobstruction due to joint incongruity, Osteophytes, or loose bodies. Contracture of thejoint capsule and the surrounding soft tissues may also contribute in more long-standing cases.3. Joint tenderness:Joint tenderness is associated with bony or soft tissue swelling. Tenderness may bedemonstrated along the joint line or in association with periarticular structures such astendons and ligaments.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   102  4. Bony Swelling:O.A. is a bone forming disease. Radiographically it is characterized by asymmetricjoint space narrowing due to cartilage loss, with reactive new bone formation. Thisfinally leads to bony swellings. The characteristics swelling of the affected joint is dueto thickening by Osteophytes. Soft tissue swelling also contributes its part.5. Deformity:O.A. of the knee may involve the femorotibial (medial) and / or Pattellofemoral(lateral) compartment. O.A of the medial compartment may result in a varus (bow-leg) deformity. Owing to the altered line of weight transmission this is usuallyprogressive and damageing. In the lateral compartment it may produce a valgus(knock-knee) deformity.6. Muscle weakness:Disability in those with knee O.A. is more strongly associated with quadriceps muscleweakness than with either joint pain or radiographic severity of the disease.7. Increased warmth:In the advanced stage of O.A., histological evidence of synovial inflammation may bemarked as that in the Synovium of a patient with rheumatoid arthritis. It may be dueto phagocytosis of shards of cartilage and bone from the abraded joint surface, torelease from the cartilage of soluble matrix macromolecules or to crystals of calciumpyrophosphate or hydroxyapatite. In this condition palpation may reveal some warmthover the joint. Synovial effusions are usually not large.8. Range of Motion:Range of motion refers to the distance and direction a joint can move to its fullpotential. Each joint has a normal range of motion that is expressed in degrees afterbeing measured with a goniometry.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   103  Limited Range of Motion:It refers to a joint that has a reduction in its ability to move. The reduced motion maybe a mechanical problem with the specific joint or it may be caused by diseases suchas Osteoarthritis, or other types of arthritis. Pain, swelling, and stiffness associatedwith arthritis can limit the range of motion of a particular joint and impair functionand the ability to perform usual daily activities.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   104  DIFFERENTIAL DIAGNOSIS168Osteoarthritis of the knee has to be differentiated from following conditions.1. Gonococcal arthritis2. Tubercular arthritis3. Rheumatoid arthritis4. Gout5. Rheumatic fever6. Acute Suppurative arthritisTable. 18. Showing the differtial diagnosis of OsteoarthritisOsteoarthritisRheumatoidarthritisGouty arthritisCausePrimary unknown ,secondary degenerativechanges due to local orsystemic involvementUnknown ObscurePattern ofjointinvolvementMono or poly articulararthritis large orsometimes small joints,knee joint mostfrequently, may or maynot be symmetricalarthritisPoly articular, largejoint, both upper andlower limb joints,symmetrical arthritisMono orpolyarticular smallMTP joints, greattoe and kneeaffected indecreasingpercentageSymptomsrelated tojointInitially intermittentaching provoked by useand relieved by rest.Swelling, stiffnessinitially due to pain,muscular spasm,capsular fibrosisosteophyte formationContinuous painprovoked by joint use,swelling, morningstiffness more than 1hour, anorexia, feverpain all over the bodyAcute agonizingpain specially atnight, swelling,severe functionalimpairment,anorexia, nausea,change in moodLabinvestigationNot specificRA test positive, ESRis raisedSerum uric acidlevel raised
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   105  AcuteSuppurativearthritisGonococcalarthritisTuberculararthritisRheumaticfeverCausePrimaryinfection,secondaryinfection toacuteosteomyelitisInfection bygonococciUsuallysecondary toestablishedfocus in lungsor other areaJointinvolvementpatternLarge joints andkneeAsymmetricalarthritisLarge joint,AsymmetricalarthritisLarge joint,AsymmetricalarthritisJointinvolvementin the formof fleetingand transientpoly arthritisSymptomsrelated tojointSevere pain injoint, red, hotswollen effusionin affected jointmarkedlimitations ofmovementsMigratory pain,tenderness,limitation ofmovementsContinuouspain,limitation ofmovementJointsbecome, hotswollen red,tender,effusedSystemicfeatureSwinging feverMaculopustular orvesicularyrashesAnorexia,weight loss,night sweats,evening riseoftemperatureChorea,carditisfever,subcutaneousnodulesLaboratoryinvestigationsESR raisedDemonstrationof gonococci inurethraldischargeESR raisedESR raised,ASLO titerabove 200,Leucocytosiscommon
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   106  Investigations169Laboratory studies: - Routine laboratory tests are usually normal so their value is inruling out other types of arthritis, especially inflammatory types of arthritis, orestablishing a baseline for monitoring treatment. Synovial fluid analysis also helpsrule out other conditions or to diagnose an underlying disorder causing secondaryO.A. If OA causes joint effusions, Synovial fluid analysis can help differentiate itfrom inflammatory arthritis; in OA, Synovial fluid is usually clear, viscous, and has ≤2000 WBC/µL.Radiographic studies:X-rays will provide a two-dimensional image of the overall structure of your knee. Itis helpful in identifying loss of joint space, arthritis, abnormal bone shapes such asbone spurs or bone cysts, fractures, and degeneration (wear and tear) on the joint. X-rays can reveal Osteophytes at the joint margins, joint space narrowing, andsubchondral bone sclerosis. Subchondral bone is the layer of bone which is just belowthe cartilage.Arthrography: This is a useful technique in peripheral Meniscal detachment, orwhen there is a suspicion of recurrent Meniscal lesions.Ultrasound is useful for visualizing joint effusions, synovitis, and periarticularstructures such as tendons, bursae, Bakers cyst especially if aspiration and injectionare required.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   107  MRI: MRI will provide more detailed information and will help to evaluate the softtissues in and around your knee joint (muscles, tendons, ligaments, menisci, and otherconnective tissues).TREATMENT170The main objectives are relief of symptoms, preservation and restoration of function of the failing joint and arresting the process of cartilage destruction. General measures  The  benign  nature  of  the  disease  and  its  course  should  be  explained  and  the need for exercises should be stressed.   Weight reduction should be encouraged.   Excessive and wrong usage of the joint should be prevented. Stressful activities like kneeling and squatting (for knee OA) should be avoided. Nonpharmacotherapy: - Since OA is a mechanically driven disease, the mainstay oftreatment involves altering loading across the painful joint and improving the functionof joint protectors, so they can better distribute load across the joint. Ways oflessening focal load across the joint include, Avoiding activities that overload the joint, as evidenced by their causing pain; Improving the strength and conditioning of muscles that bridge the joint, so as tooptimize their function; and Unloading the joint, either by redistributing load within the joint with a brace or asplint or by unloading the joint during weight bearing with a cane or a crutch.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   108   Heat therapy in the form of hot‐water baths, paraffin‐wax baths, and short‐wave diathermy are useful in relief of pain. Correction of Malalignment: - Correcting Malalignment, either surgically or withbracing, can relieve pain in persons whose knees are maligned.Pharmacotherapy:  ‐  Acetaminophen, Nonsteroidal Anti-Inflammatory Drugs(NSAIDs), and COX-2 Inhibitors. Intraarticular Injections: Glucocorticoids and Hyaluronic Acid Surgery: ‐ Indications for surgery in OA include: (a) relief of pain or severe disability after  failure  of  other  conservative  measures  and  (b)  correction  of  mechanical derangement  that  may  lead  to  osteoarthritis.  Procedures  available  for  the  knee include  osteotomy,  arthrodesis,  arthroscopic  debridement,  and  partial  and  total knee prosthesis.         
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   109      MATRABASTIEtymology of Matrabasti:Etymologically this comprised of two words i.e. ‘Matra’ and ‘Basti’.Matra171The word ‘Matra’ conveys many meanings such as measurement, quantity, size,duration, unit of time and movement.But in this context ‘Matra’ refers to measure i.e. quantity of basti dravya. Matra –Alpa.Basti172The word ‘Basti’ has its derived from the root ‘Vas’ with the suffix ‘Tich’.uÉxÉ + ÌiÉcÉç oÉÎxiÉ1) “ uÉxÉÑ – ÌlÉuÉÉxÉå oÉxÉç” –This means to stay, to reside and to dwell.2) “AÉcNûÉSlÉå” -It means to cover.Hence, Basti conveys the following meanings.oÉÎxiÉ – uÉxiÉåÈ AÉuÉ×hÉÉåÌiÉ qÉѧÉÇ | lÉÉpÉåUkÉÉåpÉÉaÉå qÉÔ§ÉÉkÉÉUå xjÉÉlÉå ( mÉÑ.) ||AÉæwÉkÉ SÉlÉÉjÉåï SìurÉpÉåSå”||
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   110   An organ where urine is collected i.e. urinary bladder, which is situated below theumbilicus. An instrument which is used to introduce Basti drugs in the rectum.Definition of Basti:oÉÎxiÉlÉÉ SÏrÉiÉå CÌiÉ oÉÎxiÉÈ| A.S. A.¾èû.xÉÔ.19/11) The drug given through this process first goes to the area of Basti.2) The procedure in which the medicaments are introduced inside the body throughthe rectum with the help of animal urinary bladder is termed as Basti. (Su. Ut. 5/1)So Basti which is given in little quantity is called as Matrabasti.  DEFINITION1. ¾ûxuÉÉrÉÉ: xlÉãWûqÉɧÉÉrÉÉ qÉɧÉÉoÉÎxiÉ: xÉqÉÉã pÉuÉãiÉç|173The oÉÎxiÉ in which the dose of xlÉãW administered is equivalent to ¾ûxuÉqÉɧÉÉ of xlÉãWmÉÉlÉ iscalled as qÉɧÉÉoÉÎxiÉ.2. ¾èxuÉrÉÉ xlÉåWûmÉÉlÉxrÉ qÉɧÉrÉÉ rÉÉåÎeÉiÉÈ xÉqÉÈ |qÉɧÉÉoÉÎxiÉÈ xqÉ×iÉÈ xlÉåWûÈ ||174Matrabasti consisting of enema material equivalent to the minimum quantity of snehaused for Snehapana therapy is known as Matrabasti.INDICATIONS OF MATRA BASTIMatra Basti is always applicable to those emaciated due to overwork, physicalexercise, weight-lifting, walking, journey on vehicles and indulgence in women,debility and suffers from vatavyadhis. (C.Si.4/52)Matra Basti used for children, aged, to those who daily indulge in walking in longdistances, lifting weights, physical exercises, too much of worry and women, kings,
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   111  lords (wealthy persons), sukumar, who have fractures of bones and poor digestivecapacity. (A.H.Su.19/67).Table 19. Showing indications of matra basti175, 176,177.SR.NO. INDICATIONS C.S. A.S. A.H.1 Karma Karshita + - -2 Bhara Karshita + + +3 Adhva Karshita + + +4 Vyayama Karshita + + +5 Yana Karshita + + -6 Stri Karshita + + +7 Durbala + + +8 Vata Rogi + + +9 Bala - + +10 Vriddha - + +11 Chintatur - + +12 Stri - + -13 Nripa - + +14 Sukumara - + -15 Alpagni - + +
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   112  CONTRA-INDICATIONSAshtanga Samgrahakara has mentioned that Matra Basti should not be administered inperson having Ajirna. (A.S.28/8)16 Sukhatma - - +
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   113  DOSE OF MATRABASTI The Dose of Matrabasti is equivalent to Hriswamatra of Snehapan. ( C.Si.4/53and A.S.28/8 ), (A.H.Su.19/67) The dose of Matra Basti is 1½ Pala (Dal. And Gayi. On Su.Chi.38/18),(Chakrapani on, C.Si.4/53), (Arundatta on A.H.Su.19/67). Kashyapa Samhita178-1. Hriswa matra- 1 Prakuncha,2. Madhyama Mtra- 1½ Prakuncha,3. Uttama Matra- 2 pala4. Apstanya balak- ½ pala. (K.khil.8/104-105) Acc. Sharangadhara1791 or 2 pala,Arohana krama Matrabasti - by Acharya Adhamalla on Sha.Ut.5/41stday 2 tola is to be given increase of dose by ½ tola per day, so that in, 9thday 1 ½pala to be reached.{If sneha lakshanas are found within that time, should be stopped} Acc. Shivadasasen on Chakradatta1801. 1stday 2 tola2. 2ndday rest3. 3rdday ½ tola is to be increased4. 4thday rest,Likewise on 17thday, 6 tola has to be givenMatrabasti Sevankala:It can administered Sarvakalam Niratyaya (at all times, in all seasons and isharmless).QUALITIES:
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   114  The Matra Basti is promotive of strength without any demand of strict regimen ofdiet, causes easy elimination of Mala. It provides happiness, performs the function ofBrimhana and cures Vatavyadhi. (Ch. Si. 4/52-54). Ashtanga Sangraha has mentionedthat Matra Basti gives happiness, strength, complexion, easy elimination of wastesand also the doshas. (A.S.28/8 )It has been told as “Niraapada, sarvaloukiki, sarvakaliki and Vriddha VyavaharaSiddhach” by Shivadasasen while commenting on Chakradatta.Pathya – Apathya:Yatheshta ahara chestasya. (C.Si.4/53); Matra Basti does not require any regimen ofdiet or behavior.Nishparihara. (A.H.Su.19/67); there are no restrictions for Matrabasti.However, Ashtanga Samgrahakara has restricted the day sleep after being treated withMatra Basti (A. S. Su. 28/9).Retention of Matra Basti:The normal Pratyagamana Kala of Sneha Basti is 3 Yama i.e. 9 hours. Being a type ofSneha Basti, the Pratyagamana Kala of Matra Basti is also 3 Yama i.e. 9 hours. Thereis no harm if Matra Basti retains in the body because, while describing AnuvasanaBasti it has been said that it is not harmful to body even in the event of its beingretained in the body for a whole day. Also the dose of Sneha in Matra Basti is verysmall, which can get easily absorbed in the body without coming out. It is believedthat Sneha Basti should be retained in the body. If Basti material returns much earlier,it cannot produce the desire effect in the body (A. H. Su. 19/29- 30).Anuvasana – Matrabasti181
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   115  Immediate action and delayed action, more benefits and less benefit are the results ofAnuvasana and Matrabasti respectively. If there is no difference between them, whowill resort to Anuvasana which is associated with controls (regarding food andactivities) and risks (complications).MODE OF ACTION OF BASTI1. Basti enters the Pakwashaya which is the main Sthana of Vata Dosha and destroysVata Dosha which is the originator of all Vikaras. By subsiding the Vata, allVikara located in the other parts of the body also become allayed just as by theeradication of the roots of a plant, the stem, branches, sprouts, fruits, leaves etc.also vanish181.2. Nutritive action of Basti:-Just as a tree fed with water at its roots, puts forth green leaves and delicatesprouts, and in due time grows into a big tree, full of blossom and fruit, similarlydoes a man grow strong by means of Anuvasana Basti183.3. Systemic action of the Basti:-The Virya of Basti drugs reach all over the body through the Srotas in the sameway as the water poured at the root of the plant reaches upto leaves. He has furtherexplained that even though Basti drugs quickly comes out alone or with Mala,their Virya act over the whole organism by the action of Apana and the otherVayu. This action takes place just like as sun draws moisture from the earth184.Astanga Samgrahakara has elaborated this thing firstly as the Virya of Basti drugsreaches the Apanavayu, and then it is handed over to Samanavayu. Afternourishing Samanavayu, it reaches the Vyanavayu; thereafter it acts onUdanavayu and Pranavayu. When all these five types of Vata get their normalstate they promote health. Then Virya of Basti drugs act on the Pitta and Kapha to
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   116  bring them in normal state and provide them nourishment. The Virya of the Bastidrugs is carried in Tiryaka Pradesha by Vyanavayu, by Apanavayu in AdahPradesha, by Pranavayu in Urdhva Pradesha. Just as whole farm gets itsnourishment by water supplied to it through channels, the whole body getsnourishment by the Virya of Basti drugs carried by five types of Vata throughSrotas185.Some commentator’s commentary is very useful to understand how Basti drugreaches all over the body and does its action.4. To understand the action of Sneha Basti, Commentator Chakrapani has quoted thereference of Parashara that Guda is the Mula of the body where all Shira arelocated. The Sneha administered through Guda reaches upto head giving thenutrition to the body. According to Amarkosha the word ‘Payu’ a synonym ofGuda gets its name from its capacity to drink Basti Dravya or oil.5. Sushruta Samhita has mentioned, Basti drug reaches first to the Pakwashaya andthen to the Grahani. Pakwashaya is the site of Purishadharakala and Grahani is thesite of Pittadharakala. So Basti directly acts on Purishadharakala andPittadharakala. Commentator Dalhana has commented on Su. Kal. 4/40 thatPurishadhara and Asthidharakala are same and Pittadharakala and Majjadharakalaare one and same186. So through Basti direct benefit is achieved to Asthi andMajja Dhatu. Majja is present in the Asthi. Also we can take Mastulunga asMastak Majja (Su. Su. 32/12 Dh). Vatanadis are also made by Majja. So by Bastiwe get benefit in the disorders of central nervous system. (Su.Chi. 37/71-74)DRUG REVIEW
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   117  Table. 20. Showing Drugs used in study187, 188.           MATERIALS AND METHODSSi.no.Name ChemicalcompositionRasaPanchakaPartsUsedKarma1 HaritakiTerminaliachebulaAnthraquinone, glycoside,chebulinicacid,chebulagicacid.Rasa: Pancharas(Lavana varjit),Guna:Laghu,Ruksha.Virya: UshnaVipaka: MadhuraPrabhava:Tridoshahara.Phala Anulomana,Vedanasthapana,Krimighna,Hridya.Shothahara.2 AshwagandhaWithaniasomniferousSomniferine,somnine,somniferininewithananine,pseudo-withanine,tropine,cuscohygrine,anferine andanhydrine.Rasa - Katu, Tikta,MadhuraGuna - Ushna,Laghu, Snigdha,SaraVirya - UshnaVipaka - MadhuraDoshaghnata -Vata KaphaShamaka.MulaandPatraRasayana,Vrushya,Balya.3 Goghrita Triglyceride  cholesterol Carotene Vit. A  Vit. EMonoglycerides  Diglycerides,  Rasa -MadhuraVirya -SheetaVipaka- MadhuraDoshaghnata-VatapittaharaAction -Deepana,Rasayana,Vrushya,AgnivardhakBalya,Ojovardhaka,KantivardhakVayasthapanaIndriyabalavridhikar4 Godugdha Fat  Minerals Lactose  Calcium Iron  Vitamin C protein Rasa: MadhuraGuna: Guru,Snigdha, MruduVirya: SheetaVipaka: MadhuraDoshaghnata:Vata-pittaShamakaJivaniya,Medhya, andBrimhana.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   118  MATERIALS:The materials and methods used for the study based on which the Literary and clinicalwork has been carried out is categorized into following three headings.1. Literary source2. Drugs3. Instruments:Collection of materials:A. Literary: A literary source for the present study was obtained from Vedicscriptures, classical texts of Ayurveda, contemporary medical text books,published articles in reputed journals and also from the various media like internetfollowed by retrospective study of related research works.B. Drugs1. Ashwagandha ghrita was purchased from Sri Dharmasthala ManjunatheshwaraAyurveda Pharmacy, Kuthpady, Udupi – 574 118.2. Ksheerabala taila was taken from GAMC and hospital, Mysore.3. Haritaki churna was purchased from Dhanawantari Ayurvedic Medical, KabirRoad, Mysroe.C. Instruments: Goniometer, 100ml Enema Syringe, No.12 rubber catheter.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   119  MethodologyBastidana vidhi- Basti dana vidhi includes purva karma, pradhana karma and paschatkarma.1. Examination of patients: Dosha, oushadha, desha, kala, sathmya, agni, satva, oka,vaya and bala, are examined before administration of basti.2. Preparation of the medicine.3. Matra nirnaya: Matra of Matrabasti basti was fixed to 60ml. The ingredients are asfollow.Matrabasti basti dravya: - Ashwagandha ghrita-60mlAnulomana:The Anulomana is essential before administration of Matrabasti. Haritaki churna wasadministered for Anulomana to all the patients.PRADHANA KARMAThe patient was asked to take light meal, neither too Snigdha nor too Rukshaand not more than 3/4thof the usual quantity. Before administration of Basti,Abhyanga with bala taila was done on the reason of Kati and Udara Pradesha.Thereafter, Nadisweda was performed. After this Purvakarma, the patient was advisedto take left lateral position with left lower leg straight and right lower leg flexed onknee and hip joint. The patient was asked to keep his left hand below the head. 60mlof lukewarm Ashwagandha Ghrita was taken in enema syringe. After removing the airfrom enema syringe, rubber catheter was administered into the anus of the patientupto the length of 4 inches. The patient was asked to take deep breath whileintroducing the catheter and drug. The total ghrita was not administered in order toavoid entrance of Vayu into the Pakwashaya which may produce pain. After the
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   120  administration of basti patient was advised to lie in supine position and patient’sbuttocks were gently tapped and legs were raised few minutes so has to raise thewaist. All these were done to prevent the fluid from flow out too soon. Aftersometime patient was advised to get up from the table and take rest in their bed.METHODSAimThe present work was under taken for the “a study on Jara w.s.r. to role of Matrabastiin Janusandhigatvata (knee osteoarthritis)”OBJECTIVES OF THE STUDY:1. To systematically compile and analyse Jara.2. To study Aetiopathogenesis of Janusandhigatavata in elderly, with Ayurvedic aswell as Modern focus.3. To observe the effect of Ashwagandha Ghrita Matrabasti in Janusandhigatavata.(Knee Osteoarthritis).Source of the dataPatients of either sex diagnosed as Janusandhigatavata were selected from the O.P.Dand I.P.D of GAMC Hospital Mysore. A special free camp was conducted forJanusandhigatavata in the campus of GAMC Hospital Mysore.Research Design A comparative literary study of Ayurvedic literature on Jara with current updatedview (western medicine). A clinical study where the incidentally selected 30 patients in one group.SELECTION CRITERIA1. Patients diagnosed as Janusandhigatavata after preliminary examination.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   121  2. Patients were selected with respect to age and irrespective of sex, caste,occupation and socioeconomic status.3. Patients fulfilling inclusion criteria.4. Patients willing to participate in the study were selected by explaining them theintervention in detail.DIAGNOSTIC CRITERIA:Subjective parameters:1. Shoola2. Shotha3. Atopa4. Vatapurna dhruti sparsha.5. Prasarana akunchanayo vedana.Objective parameter:X-ray: Knee Joint AP and Lateral view.INCLUSION CRITERIA:1. The individuals coming under diagnostic criteria were selected for the study.2. The individuals of either sex between the age group 60-75 years were selected forthe study.3. Patients diagnosed as primary Knee Osteoarthritis were taken for the study.4. Patients fit for Matrabasti were taken for the study.EXCLUSION CRITERIA: All the patients with secondary Knee Osteoarthritis were excluded. Patient’s having other systemic disorders which may interfere with the course ofthe disease and its management was excluded.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   122   Patients who are incapacitate, bedridden and confined to wheel chair wereexcluded.InvestigationFollowing investigation was performed before treatment and at the end of the followup.X-ray of knee joint.INTERVENTIONThe intervention of clinical study was carried as mentioned below.1. The patients were administered with Haritaki churna in appropriate doses forAnulomana.2. Then patients were subjected to Abhyanga (Udara, Kati and Janusandhi) byKsheerabala taila followed by Nadisweda before each basti.3. Ashwagandha ghrita Matrabasti, in a dose of 60ml was administered by rectalroute after a light food. The duration of the treatment was 9 days which wasfollowed by a follow up period of 18 days.METHODS OF ASSESSMENT OF TREATMENTASSESMENT CRITERIA:WOMAC scale.The results were assigned on the basis of WOMAC Osteoarthritis index.The Western Ontario and Mac-master Osteoarthritis Index is a disease specific, selfadministered health status measure. It probes clinically important symptoms in thearea of pain, stiffness and physical function in patients with osteoarthritis of the hip orknee. The index consists of 24 questions (5- pains, 2 -stiffness and 17 -physical
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   123  functions) and can be completed in short duration. WOMAC is a valid, reliable andsensitive instrument for the detection of clinically important changes in health statusfollowing a variety of interventions, pharmacologic, surgical etc.Individual question responses are assigned a score between 0 (None) to 4 (Extreme).Individual question scores are then summed to form a raw score ranging from 0(best)to 96 (worst). The above arthritis index comprises of following questions.Pain: Severity on average during the past month of;1. Pain - Walking2. Pain - Stair climbing3. Pain - Nocturnal4. Pain - Rest5. Pain - Weight bearingStiffness:1. Morning stiffness2. Stiffness occurring during the dayLevel of difficulty in performing the following functions1. Descending stairs2. Ascending stairs3. Rising from sitting4. Standing5. Bending to the floor6. Walking on flat surface7. Getting in and out of a car8. Going shopping
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   124  9. Putting on socks10. Rising from bed11. Taking off socks12. Lying in bed13. Getting in and out of bath14. Sitting15. Getting on and off toilet16. Heavy domestic duties17. Light domestic dutiesThe WOMAC gradings are;0 = None1 = Slight2 = Moderate3 = Severe4 = ExtremeTo suit the Indian conditions the following 18 questions were selected to beretained in the questionnaire:Pain:1. Standing: 2. Going up and down stairs: 3. At night while in bed: 4. Rest (sitting or lying): 5. Standing upright: Stiffness:
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   125  1. Morning stiffness: 2. Stiffness occurring during the day: Level of difficulty in performing the following functions1. Ascending stairs: 2. Descending stairs: 3. Rising from sitting: 4. Walking on flat surface: 5. Sitting: 6. Light domestic duties: 7. Walking on flat surface: 8. Getting in / out of bed: 9. Getting in / out of toilet: 10. Getting in / out of bath: 11. Bending to the floor: In the above questionnaire the scores ranged between 0-72.0 = Being best72 = Being worstData as response to the above questions were collected.A. On day 0 ie. Before treatmentB. On 9thday ie. After treatmentC. On 27thday ie. After follow up.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   126  Overall AssessmentOverall assessment was done on basis of following criteriaA. Complete relief – Score reduced to 0B. Marked improvement – Reduction in score between 21-30 pointsC. Moderate improvement – Reduction of score between 11-20pointsD. Slight improvement – Reduction in score between 0-10 points Statistical Analysis was done by using Chi- Square test, Contingency Co-efficientTest and Repeated Measures ANOVA. All the statistical methods were carried outthrough the SPSS (Statistical presentation system software) for Windows (version16.0) and Minitab (version 11.0).
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   127  OBSERVATIONS AND RESULTSOBSERVATIONSThe study registered 30 patients.Observations of the patients is tabulated below.Table 21. Showing the age group incidence.Age(inyears)No. of patients Percentage60-65 15 50.066-70 8 26.771-75 7 23.3Maximum incidence was seen in 60-65 yrs i.e. 15 (50%) patients followed by 66-70yrs i.e. 8(26.7%) patients, finally least in 71-75 yrs i.e. 7(23.3%) patients.Table 22. Showing the incidence of religion.In the present study it was observed that majority of patients were from Hinducommunity i.e., 29 (96.7%) and from Muslim community were only 1(3.3%).Table 23. Showing the incidence of sex.Religion No. of patients PercentageHindu 29 96.7Muslim 01 3.3
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   128  Sex No. of patients PercentageMale 18 60Female 12 40In the present study it was observed that more number of patients was male’s i.e.18,(60.0%) and female patients were 12 (40.0%).Table 24. Showing the incidence of occupation.Occupation No. of patients PercentageHousewife 12 40Labour 11 36.7Buisness 07 23.3In this study it was observed that majority of the patients were housewives i.e. 12(40.0%) followed by labour were 11(36.7%) and of buisness were 7 (23.3%).Table 25. Showing the incidence of education.Education No. of patients PercentageIlliterate 14 46.7Primary school 04 13.3Middle school 06 20Graduates 06 20In the present study it was found that the majority of patients were illiterate i.e.,14(46.7%) primary educated were 4(13.3%) middle schools were 6 (20.0%) andgraduates were 6(20%).Table 26. Showing the prevalence of dietDiet No. of patients Percentage
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   129  Vegetarian 21 70Mixed 09 30In the present study it was found that the patients with vegetarian diet were 21 (70%)and mixed diet were 9 (30%).Table 27. Showing the prevalence of ChronicityChronicity No. of patients PercentageUpto 5 yrs 16 53.36-10 yrs 10 33.310+ 04 13.3In the present study it was found that 16 patients had the chronicity upto 5yrs,followed by 10 patients had chronicity 6-10 yrs and 4 patients had chronicity for morethan 10 yrs.Table 28. Showing the prevalence of Socio - economic statusSocioeconomicstatusNo. of patients PercentagePoor 18 60Middle 11 36.7Rich 01 3.3In the present study it was found that majority of the patients belong to poor class i.e.,18(60%) followed by middle class were 11 (36.7 %) and rich was only 1 (3.3%).Table 29. Showing the incidence of locality of patients.Habitat No. of patients PercentageRural 19 63.3
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   130  Urban 11 36.7In the present study it was found that the patients from rural area were more i.e., 19(63.3%) and patients belonging to urban area were 11 (36.7%).Table 30. Showing the incidence of Deha prakrutiPrakruti No. of patients PercentageVataja 2 6.7Vata pitta 3 10Vata kapha 24 80Pitta kapha 1 3.3In the present study 24 (80%) patients belonged to Vata kapha prakruti, 3 (10%)patients belonged to vata pitta prakruti, 2 (6.7%) patients belonged to vataja prakrutiand 1(3.3%) patient belonged to pitta kapha prakruti.Table 31. Showing the incidence of SaraSara No. of patients PercentageMadhyama 22 73.3Avara 8 26.7In the present study most of the patients i.e. 22(73.3%) had Madhyama Sara and8(26.7%) patients had Avara Sara.Table 32. Showing the incidence of SamvahanaSamhanana No. of patients Percentage
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   131  Madhyama 22 73.3Avara 8 26.7In the present study most of the patient’s i.e. 22(73.3%) had Madhyama Samvahanaand 8(26.7%) patients had Avara Samvahana.Table 33. Showing the incidence of SatvaSatva No. of patients PercentageMadhyama 24 80Avara 6 20In the present study most of the patients i.e. 24 (80%) had Madhyama Satva and6(20%) patients had Avara Satva.Table 34. Showing the incidence of BalaBala No. of patients PercentageMadhyama 9 30Avara 21 70In the present study most of the patients i.e. 21 (70%) had avara Bala and 9 (20%)patients had madhyama Bala.RESULTSThe assessment criteria i.e. WOMAC Arthritis index was applied and scores wereallotted on Day ‘0’ i.e. before treatment, 9thday i.e. after treatment, 27thday i.e. afterfollow up. The scores were analysed by applying “Contingency Coefficient” and“Repeated measures ANOVA”.Table 35. Showing Pain while walking on flat surfaceMild Moderate Severe TotalBefore8(26.7%) 21(70.0%) 1(3.3%) 30(100.0%)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   132  After22(73.3%) 8(26.7%) 0.0% 30(100.0%)Follow up24(80.0%) 6(20.0%) 0.0% 30(100.0%)Total54(60.0%) 35(38.9%) 1(1.1%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal ContingencyCoefficient.442 .000N of Valid Cases 90P< 0.001(HS)The result of treatment in pain on walking showed highly significant improvement.Table  36. Showing  Pain while going up and down stairs Mild Moderate Severe Ext TotalBefore 0(.0%) 8(26.7%) 20(66.7%) 2(6.7%) 30(100.0%)After 2(6.7%) 23(76.7%) 5(16.7%) 0(.0%) 30(100.0%)Follow up 2 (6.7%) 23(76.7%) 5(16.7%) 0(.0%) 30(100.0%)Total 4(4.4%) 54(60.0%) 30(33.3%) 2(2.2%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal ContingencyCoefficient.496 .000N of Valid Cases 90P< 0.001(HS)The result of treatment in pain on going up and down stairs showed highly significant improvement.  Table 37. Showing  Pain at night while in bed Mild Moderate Severe TotalBefore 13(43.3%) 16(53.3%) 1(3.3%) 30(100.0%)After 24(80.0%) 6(20.0%) 0(.0%) 30(100.0%)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   133  Follow up 26(86.7%) 4(13.3%) 0(.0%) 30(100.0%)Total 63(70.0%) 26(28.9%) 1(1.1%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal Contingency Coefficient .391 .003N of Valid Cases 90P< 0.05 (SS)The result of treatment in pain at night while in bed showed statistically significantimprovement.Table 38. Showing Pain at rest (sitting or lying)None Mild Moderate TotalBefore 2(6.7%) 23(76.7%) 5(16.7%) 30(100.0%)After 7(23.3%) 23(76.7%) 0(.0%) 30(100.0%)Follow up 7(23.3%) 23(76.7%) 0(.0%) 30(100.0%)Total 16(17.8%) 69(76.7%) 59(5.6%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal ContingencyCoefficient.357 .011N of Valid Cases 90P< 0.05 (SS)The result of treatment in pain at rest (sitting or lying) showed statistically significantimprovementTable 39. Showing Pain on weight bearingNone Mild Moderate TotalBefore 0(.0%) 21(70.0%) 9(30.0%) 30(100.0%)After 2(6.7%) 21(70.0%) 7(23.3%) 30(100.0%)Followup3(10.0%) 22(73.3%) 5(16.7%) 30(100.0%)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   134  Total 5(5.6%) 64(71.1%) 21(23.3%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal Contingency Coefficient .206 .410N of Valid Cases 90P> 0.05 (NS)The result of treatment in pain on weight bearing showed no significant improvement.Table 40. Showing Morning StiffnessMild Moderate TotalBefore 6(20.0%) 24(80.0%) 30(100.0%)After 21(70.0%) 9(30.0%) 30(100.0%)Followup16(53.3%) 14(46.7%) 30(100.0%)Total 43(47.8%) 47(52.2%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal Contingency Coefficient .384 .000N of Valid Cases 90P< 0.001(HS) The result of treatment in morning stiffness showed highly significant improvement. Table 41. Showing Stiffness occurring during the day None Mild Moderate TotalBefore 6 (20.0%) 21(70.0%) 3(10.0%) 30(100.0%)After 10(33.3%) 20(66.7%) 0(.0%) 30(100.0%)Follow up 12(40.0%) 18(60.0%) 0(.0%) 30(100.0%)Total 28(31.1%) 59(65.6%) 3(3.3%) 90(100.0%)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   135  Symmetric MeasuresValue Approx. Sig.Nominal by Nominal ContingencyCoefficient.290 .083N of Valid Cases 90P> 0.05 (NS)The result of treatment in stiffness occurring during the day showed no significant improvement.  Difficulty in performance of following activities.Table 42. Showing difficulty in Ascending stairs  Mild Moderate Severe TotalBefore 0(.0%) 11(36.7%) 19(63.3%) 30(100.0%)After 2(6.7%) 23(76.7%) 5(16.7%) 30(100.0%)Follow up 4(13.3%) 20(66.7%) 6(20.0%) 30(100.0%)Total 6(6.7%) 54(60.0%) 30(33.3%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal Contingency Coefficient.431 .000N of Valid Cases 90P< 0.001(HS) The result of treatment in ascending stairs showed highly significant improvement.  Table 43. Showing difficulty in Descending stairs Mild Moderate Severe Ext TotalBefore 0(.0%) 9(30.0%) 20(66.7%) 1(3.3%) 30(100.0%)After 1(3.3%) 16(53.3%) 13(43.3%) 0(.0%) 30(100.0%)Follow up 1(3.3%) 12(40.0%) 17(56.7%) 0(.0%) 30(100.0%)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   136  Total 2(2.2%) 37(41.1%) 50(55.6%) 1(1.1%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal ContingencyCoefficient.259 .372N of Valid Cases 90P> 0.05 (NS) The result of treatment in descending stairs showed no significant improvement.  Table 44. Showing difficulty in Rising from sitting   Mild Moderate Severe TotalBefore 5(16.7%) 24(80.0%) 1(3.3%) 30(100.0%)After 18(60.0%) 12(40.0%) 0(.0%) 30(100.0%)Follow up 13(43.3%) 17(56.7%) 0(.0%) 30(100.0%)Total 36(40.0%) 53(58.9%) 1(1.1%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal ContingencyCoefficient.359 .010N of Valid Cases 90P< 0.05 (SS)The result of treatment in rising from sitting showed statistically significantimprovementTable 45. Showing difficulty in Standing None Mild Moderate TotalBefore 1(3.3%) 21(70.0%) 8(26.7%) 30(100.0%)After 2(6.7%) 24(80.0%) 4(13.3%) 30(100.0%)Follow up 2(6.7%) 26(86.7%) 2(6.7%) 30(100.0%)Total 5(5.6%) 71(78.9%) 14(15.6%) 90(100.0%)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   137  Symmetric MeasuresValue Approx. Sig.Nominal by Nominal ContingencyCoefficient.228 .294N of Valid Cases 90P> 0.05 (NS)The result of treatment in Standing showed no significant improvement.   Table 46. Showing difficulty in Sitting None Mild TotalBefore 5(16.7%) 25(83.3%) 30(100.0%)After 15(50.0%) 15(50.0%) 30(100.0%)Follow up 12(40.0%) 18(60.0%) 30(100.0%)Total 32(35.6%) 58(64.4%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal ContingencyCoefficient.280 .022N of Valid Cases 90P< 0.05 (SS)The result of treatment in Sitting showed statistically significant improvementTable 47. Showing difficulty in Bending to the floor Mild Moderate TotalBefore 14(46.7%) 16(53.3%) 30(100.0%)After 23(76.7%) 7(23.3%) 30(100.0%)Follow up 20(66.7%) 10(33.3%) 30(100.0%)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   138  Total 57(63.3%) 33 (36.7%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal ContingencyCoefficient.251 .049N of Valid Cases 90P< 0.05 (SS)The result of treatment in Bending to the floor showed statistically significantimprovement.   Table 48. Showing difficulty in Walking on flat surface Mild Moderate TotalBefore 16(53.3%) 14(46.7%) 30(100.0%)After 21(70.0%) 9(30.0%) 30(100.0%)Follow up 26(86.7%) 4(13.3%) 30(100.0%)Total 63(70.0%) 27(30.0%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal ContingencyCoefficient.285 .019N of Valid Cases 90P< 0.05 (SS)The result of treatment in Walking on flat surface showed statistically significantimprovement Table 49. Showing difficulty in Getting in / out of bed None Mild Moderate TotalBefore 0(.0%) 23(76.7%) 7(23.3%) 30(100.0%)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   139  After 1(3.3%) 23(76.7%) 6(20.0%) 30(100.0%)Followup0(.0%) 22(73.3%) 8(26.7%) 30(100.0% )Total 1(1.1%) 68(75.6%) 21(23.3%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal ContingencyCoefficient.158 .678N of Valid Cases 90P> 0.05 (NS)The result of treatment in Getting in / out of bed showed no significant improvement. Table 50. Showing difficulty in Getting in / out of toilet Mild Moderate Severe Ext TotalBefore 0(.0%) 10(33.3%) 17(56.7%) 3(10.0%) 30(100.0%)After 1(3.3%) 20(66.7%) 9 (30.0%) 0(.0%) 30(100.0%)Follow up 2(6.7%) 15(50.0%) 13(43.3% ) 0(.0%) 30(100.0%)Total 3(3.3%) 45(50.0%) 39(43.3%) 3(3.3%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal Contingency Coefficient.365 .032N of Valid Cases 90P< 0.05 (SS)The result of treatment in Getting in / out of toilet showed statistically significant improvement     Table  51. Showing difficulty in Getting in / out of bath Mild Moderate TotalBefore 6(20.0%) 24(80.0%) 30(100.0% )After 15(50.0%) 15(50.0%) 30(100.0%)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   140  Follow up 10(33.3%) 20(66.7%) 30(100.0%)Total 31(34.4%) 59(65.6%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by Nominal ContingencyCoefficient.250 .050N of Valid Cases 90P< 0.05 (SS)The result of treatment in Getting in / out of bath showed statistically significantimprovement.   Table 52. Showing difficulty in Light domestic duties  None Mild Moderate Severe TotalBefore 0(.0%) 8(26.7%) 20(66.7%) 2(6.7%) 30(100.0%)After 1(3.3%) 19(63.3%) 10(33.3%) 0(.0%) 30(100.0%)Follow up 0(.0%) 16(53.3%) 14(46.7%) 0(.0%) 30(100.0%)Total 1(1.1%) 43(47.8%) 44(48.9%) 2(2.2%) 90(100.0%)Symmetric MeasuresValue Approx. Sig.Nominal by NominalContingency Coefficient .367 .030N of Valid Cases 90P< 0.05 (SS)The result of treatment in Light domestic duties showed statistically significantimprovement.This describes the overall results in 3 sections of WOMAC Scale,Table 53. Showing overall results in Pain sectionPain Mean Standard deviation Number
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   141  BT 8.5667 1.99453 30AT 6.5 1.79559 30AFU 6.2667 1.43679 30Source Type III sumof squaresdf MeansquareF SignificanceChange 96.156 2 48.078 41.925 .000Error (change) 66.511 58 1.147P< 0.001(HS) The result of treatment in Pain section showed highly significant improvement.   Table 54. Showing overall results in Stiffness section Stiffness Mean Standard deviation NumberBT 2.7 .87691 30AT 1.9667 .71840 30AFU 2.0667 .90719 30Source Type III sumof squaresdf MeansquareF SignificanceChange 9.489 2 4.744 12.597 .000Error(change)21.844 58 .377P< 0.001(HS) The result of treatment in Stiffness section showed highly significant improvement. Table 55. Showing overall results in Physical activities sectionPhysicalactivitiesMean Standard deviation Number
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   142  BT 19.9 3.80879 30AT 16.2333 3.60730 30AFU 16.8 3.20990 30Source Type IIIsum ofsquaresdf MeansquareF SignificanceChange 233.756 2 116.878 49.756 .000Error(change)136.244 58 2.349P< 0.001(HS) The  result  of  treatment  in  Physical  activities  section  showed  highly  significant     improvement. Table 56. Showing the overall results in WOMAC ScaleWomacscaleMean Standard deviation NumberBT 31.1667 6.29221 30AT 24.7 5.52830 30AFU 25.1333 4.98780 30Source Type III sum ofsquaresdf MeansquareF SignificanceChange 784.067 2 392.033 84.028 .000Error(change)270.6 58 4.666 .000P< 0.001(HS) The result of treatment in WOMAC Scale showed highly significant improvement.Table 57. Showing the results in Flexion-Right knee
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   143  Flexion-RightkneeMean Standard deviation NumberBT 111.2 6.04238 30AT 120.5667 6.26805 30AFU 119.6 7.58674 30Souce Type III sumof squaresdf Mean square F SignificanceChange 1592.289 2 796.144 127.192 .000Error(change)363.044 58 6.259P< 0.001(HS)The result of treatment in Flexion-Right knee showed highly significant improvement.Table 58. Showing the results in Flexion of Left kneeFlexion-Left kneeMean Standard deviation NumberBT 112.4333 5.02877 30AT 120.5333 4.70314 30AFU 122.1667 6.54472 30Source Type III sumof squaresdf MeansquareF significanceChange 1630.156 2 815.078 107.480 .000Error(change)439.844 58 7.584P< 0.001(HS)The result of treatment in Flexion-Left knee showed highly significant improvement.Table 59. Results on overall Improvement
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   144  Gradings Patients PercentageNo Improvement 1 3.3%Mild Improvement(Reduction in score by 0-10 points)27 91.1%Moderate Improvement(Reduction in score by 11-20 points)2 6.6%Marked Improvement(Reduction in score by 21-30 points)0 0%Complete Improvement(Score reduced to 0)0 0%Total 30 100%No improvement seen in 1 patient, mild improvement seen in 27 patients, moderateimprovement seen in only 2 patients.Illustration 1. Showing the result in Pain at walking on flat surface Illustration 2. Showing the result in Pain at going up and down stairs 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   145  Illustration 3. Showing the result in Pain at night while in bed Illustration 4. Showing the result in Pain at Rest (sitting or lying)Illustration 5. Showing the result in Morning Stiffness
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   146  Illustration 6.Showing the result in Ascending stairs   Illustration 7. Showing the result in Rising from sittingIllustration 8. Showing the result in Sitting  
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   147  Illustration 9. Showing the result in Bending to the floor Illustration 10. Showing the result in walking on flat surface
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   148   Illustration 11. Showing the result in getting in / out of toilet   Illustration  12. Showing the result in getting in / out of bath  Illustration 13. Showing the result in light domestic duties 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   149  Illustration 14. Showing the overall results in Pain section of WOMAC ScaleIllustration 15. Showing the overall results in Stiffness section of WOMAC ScaleIllustration 16. Showing the overall results in Physical activities section ofWOMAC Scale
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   150  Illustration 17. Showing Overall results in WOMAC ScaleIllustration 18. Showing Overall Improvement in Patients.  DISCUSSION“The aim of discussion, should not be victory, but progress”– Joseph JoubertDiscussion with Shastra as base establishes a concept. Study of any concept undervarious headings gives its complete orientation, but correct understanding and properinterpretation of the concept helps to achieve the determined goal and it is possibleonly with the help of discussion i.e. Upanaya. Thus, the discussion paves the way forthe conclusion i.e. Nigamana, which is the final step of complete work.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   151  The conceptual study of the process of Jara has been described under variousheadings. The possible reasoning and logical interpretation of the same is presentedhere after.Discussion on Title“A study on Jara w.s.r. to role of Matrabasti in Janusandhigatvata”The urge to live, the fear of death, the desire of youth, the distaste for old ageand the quest for Rejuvenation have always interested mankind from antiquity tomodern times. Ageing is a deleterious, progressive, universal and thus far irreversible.Old age followed by death has been so accepted as a fact of life. The tremendousadvances made in biological and medical research have succeeded in controllingseveral diseases. While this research has decreased the death rate of young people, atthe same time pushed a larger number of people into period of old age. Neither theduration of youthful life nor the maximum life span has been prolonged, only theaverage life span has been increased. This has resulted in an ever increasing numberof old people in every nation. The problem before the scientists, therefore, is how tokeep the old people physically fit and how to make them useful to society.Ayurveda system of Medicine offers an excellent line of Management forthese “Jaravikars” That was the reason why “JARA- CHIKITSA” has been mentionedas one independent anga in Ashtanga Ayurveda. It implies delaying the process ofageing and manageing the problems of old age.Jara is Swabhavika vyadhi which is natural, unavoidable, and palliable. In factno treatment can prevent old age or changes that occur due to age, but the process canbe delayed. Therefore a detailed study of JARA in the light of recent developments inthe field of Geriatrics is very much essential to understand, analyse and revalidate theprinciples related to Jara.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   152  This research work is not only describing the conceptual part of the subject butit also deals with its applicability (Clinical study). Clinical trial is the most importantpart of any medical study; this is directly concerned with hypothesis. For this purposea very common problem Janusandhigatavata in aged peoples had been selected andstudied. Janusandhigatavata a vata vyadhi which is equated to Gon-arthrosis incontemporary science stands top in the list of old age diseases. 80% of old age peoplehave radiological evidence of Osteoarthritis, though 25-30% is symptomatic. Gon-arthrosis is a major cause of disability; limiting activity such as walking, dressing,bathing etc. and impaired quality of life especially among elderly, the disease is morecrippling in its advanced stage. Till date no medicine is available which prevents orreverses or blocks the disease process. Treatment that will slow down or halt diseaseprogression is critically needed. It is at this juncture the world expects to find asolution in Ayurveda.According to Ayurveda, Chikitsa is “Samprapti Vighatana”. So in case ofJanusandhigatavata, treatment should be like that which makes Agnisamata,Vatashamana, Kapha Vriddhi (increase Snigdha guna), correct Khavaigunya and itshould have Rasayana property to overcome Dhatukshaya. Here, an effort has beenmade in search of its treatment which slow down or halt the disease progression ofJanusandhigatavata. Ashwagandha Ghrita Matrabasti along with local Abhyanga ofKsheerabala Taila and Nadi Swedana are selected for the present study which canhelp in slowing down the disease progression. Matra basti is most indicated procedurein Vriddhas due to property of Balya, Vatahara and Agni sandhukshana.Discussion on Derivation
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   153  The word ‘Jara’ means loss of age. The word Geriatric has also a close link with theSanskrit word “Geeryadi” which means degenerated i.e. state of deterioration due tolong use or usage of body tissues. The word "Ageing" means, the process of growingold, resulting in part from a failure of body cells to function normally or to producenew body cells to replace those are dead or malfunctioning. The ‘Jara’ understood as‘Paka’ i.e. conversional process. The “Dhatupaka”, probably identified as technicalterm with reference to ‘tissue ageing’ in Ayurveda is suitable. Where the tissues aregrowing older and transformed from active building state to the morbid state, ofcourse the morbid growth is disease and the melancholic state is death. Thus the word"Jara" is similar to that of ageing, and it conveys the meanings like; A particularperiod of life, where the body tissue attain deterioration or flaccidity.Dhatupaka: -Charaka Samhita, while describing “Dhatupaka” encapsulated the continuousdegenerative process occurring in the human body and further state that irreversibilityof this process. Chakrapani comments on above statement that, the process ofdestruction does not need any cause as such. It is automatic; the reason is that theprocess of destruction is too quick to allow any other causative factor to leave anyimpact there on. Sushruta Samhita expressed a similar view while discussingquantities of various dhatus etc. It elaborated that “Giving the exact quantity ofvolume of bodily components is impossible, owing to the ever changing internalenvironment”.Cells can die by either of two fundamentally different mechanisms:1. Apoptosis or programmed cell death, which entails controlled reactions thatprevent the dispersion of cellular contents into the surrounding tissue.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   154  2. Necrosis which entails cell lysis into the surrounding tissue.Both modes of cell death may contribute to age-related pathologies.Discussion on Definition: -Jara is defined as "a Swabhavika vyadhi (natural disease) that occurs at the 3rddeteriorating phase of life which is between the ages of 60--100 years. This isupachararahita (untreatable), Yapya (palliable), kalakrita vyadhi (timely occurring).Ageing is defined as - a natural, invariable, inevitable biological phenomenon. In theword of Seneca old age is an incurable disease. Disease accompanies ageing butageing is not a curable disease. To summarise Jara can be defined as a natural,inevitable, 3rd phase of life after the age of 60 or 70 years and associated with declineof physical and mental function with predominance of Vatadosha.Discussion on SynonymsThe terms which are used in Amarkosha to describe the aged individuals likeVisramsa, Pravaya, Vruddha, Jaran, Jeerna, and Sthavir. Most of these synonyms arederogatory implying that these individuals have lost their capability to be physically,mentally, economically and socially.Discussion on Jara avastha (old age)According to Charaka Samhita the age above 60 yrs taken as old age, but SushrutaSamhita increases this limit to 70 yrs. This difference of Charaka and Sushruta maybe due to the reason that every phenomenon has got its starting point at which it maynot be very obvious but after some time when the phenomenon advances sufficientlyits effects are clearly visible. In this way there is always a gap between the startingpoint and the complete manifestation of every phenomenon, which may be short or
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   155  long depending upon the various conditions. In case of Ageing the phenomenongenerally progresses slowly and starts at the age of about 60 and its effects are quitevisible at the age of 70 yrs. Charaka being a physician might have appreciated thechanges of Ageing at their starting point and therefore he has taken 60 years andabove as the old age. On the other hand Sushruta might have thought it safer to takethe limit of Ageing as 70 years when most of the symptoms of Ageing are quitevisible.According to contemporary science, old age considered after 60 years onwards. Thecutoff point prescribed by United Nations from 60 years onwards all individuals areelderly irrespective of the age they attain. However, recent studies carefullyconducted in physiology, biochemistry and epidemiology have confirmed that all theaged individuals cannot be put into one homogenous group. W.H.O. breaks down theold age into 3 categories they are as follows, Young old - between the ages of 60-75 years Old - old - between the ages of 75-85 years Very old - between the age of 86 years and aboveThe first old age category is physically active and mentally alert, second old agecategory most cases they are dependent on others. While the third old age categoryneeds all types of support, health, being the major one. To summaries the old ageconsidered by Charaka, i.e. 60 years and onwards is seems to be similar to that ofmodern science which is accepted worldwide.Discussion on Life span
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   156  Most of the Acharyas have considered 100 years as maximum age. Chakrapaniopines that for those who live more or less than 100 years, their life span is furtherclassified as Pravara, Madhyama, and Avarayu by considering Dashavidha Pariksha(excluding vikriti) and Ayulakshana. Further he mentions that the Pravara Ayu is 120years and it will gain by those person who having the Prakrutyadi uttama bala,dirghayu lakshana. According to contemporary medical science, the maximum lifespan for humans is 120 years; Extension of expected lifespan can often be achievedby good diet, exercise and avoidance of hazards such as smoking etc. Maximumlifespan is determined by the rate of ageing for a species inherent in its genes and byenvironmental factors.Discussion on Types of Jara:Kalaja Jara Kalaja Jara is Swabhavika means natural one. It occurs inspite of prevention andwhich is untreatable, palliable, and timely occurring and requiring supernaturalrejuvenation to reverse agony. Even in contemporary science, in spite of so muchadvancement the reason for this is not known.Akala JaraA unique concept of geriatric is hidden in Ayurvedic medicine, explaining the factorsaccelerating the ageing process. Charaka Samhita has given a very brief and beautifuldescription of factors which are responsible for vitiation of doshas in body andultimately result in manifestation of old age. Even after thousands of year today thesefactors are implemented in present day situation as such. Various dietary factors are
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   157  included, faulty food habits as like we are indulging a lot in fast food nowadays.Various factors like indulgence in excessive sexual activities and today’s youthindulgence alcoholic drinks and other addictions also were described for prematureageing. In today’s busy and competitive life the psychological factors like fear,hunger etc. and overwork, night duty are also carrying the manifestations ofpremature ageing. All these factors coupled with the “Live fast and die fast” and suchindividual are prone to have "akalamrutyu" i.e. senescence followed by death prior tothe schedule age. Such type of ageing is considered as: Aniyatayu (unscheduledageing). Chakrapani considered the occurrence of premature ageing, in personshaving the features of short life span (Avarayu).To summarise, the concept of normal and premature ageing are similar according toAyurveda and modern science. There are no causative factors exist for kalajajara,where as Akalaja Jara has got factors like diet, environment, personal habits, andgenetic factors, which accelerate the ageing process and hence premature ageing andit can be equated with the adult progeria.. The Werners syndrome (Child progeria)explained by contemporary science has got similarities to that of feature of Avarayuas explained by Chakrapani.Discussion on Decade wise Ageing process“While man is growing, life is in decrease; and cradles rock us nearer to thetomb” - YoungThough a person is said to be growing, actually he loses gradually some of hisattributes which were rightly observed by ancient Acharyas. They have observed thata particular faculty gets deteriorated with each decade. Vagbhata was the first one to
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   158  record such an observation which was followed later by Sharangadhara. From theabove quotations, it is clear that ageing does not occur simultaneously in all thetissues. Different body tissues are affected with ageing at different time period.Gradual declination of a particular faculty takes place in each decade of life and bythe end of decade, that particular faculty is lost. Vagbhata limits the life span ofhuman beings to hundred years whereas Sharangadhara extends it further by twentyyears. This is true till today as is supported by observations made by modernscientists. The nature of reactivity within the organism is an inherent phenomenon.Starting at the moment of conception, right into extreme old age, human bodyundergoes considerable change in size, shape and composition. The most dramaticchanges take place during the first fraction of life, in Uterus, but change is continuousprocess and it runs throughout the lifespan. The process of ageing adversely affectsalmost all tissues, organs and physiological functions within the organism, andpharmacology of the individual although not all functions deteriorate at the same rateor to same extent. The overall effect of these changes is produced by severalsequential events and is summed up in an increase in the probability of death of anorganism.Discussion on Theories of ageingSeveral researches have proposed a number of theories to explain “Why weAge”, the solution to this puzzle remains elusive inspite of extensive investigations,but it appears that ageing is a multi component process and it occurs due to eventual
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   159  breakdown of maintenance which is the inevitable consequence of evolved anatomicaland physiological design of the organism. Ageing of organism is generally manifestedin organs tissues and cells, which in turn is brought about by changes in molecules.Age-related changes do not occur uniformly in individuals; rather they are controlledjointly by genetic and environmental factors, which further heighten the difficulty offinding a universal theory. From above explanation it is evident that the genetic andnon-genetic theories ultimately speak about the derangement in cell structure andfunctions which results in cellular senescence.In conclusion, it can be pointed-out that there is no single and completeconcept on the ageing process in Contemporary medicine. Different theories havebeen put forth, which have been discussed. The ultimate cause of ageing isdeterioration of Jeevaparamanus i.e. Dhatus, Srotas, Malas, Indriyas, which are underconstant interaction with the Tridoshas. In the context of Jarajanya vikaras, Vatadoshais predominant; Pitta is irregular, while Kapha is in a depleted state. This cascade ofevents targets the “Vyadhikshamatva” as well as Satva of the Vruddha, submerginghim in diseases.On keen observation it seems that the above said modern and Ayurvedic theories havegot some what similarities as follows.Table 60. Showing theories and similarities of ageing processSL.NOTHEORIES SIMILARITIES1 Sahaja and programmed ageingtheoryAgeing is predetermined presumablygenetic.2 Ayu Upaghata and Apoptosistheory (Cellular senescence), WearProcess of systematically dismantlingkey cellular components.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   160  and tear3 Impaired Dhatu vyuhakarata andGene regulation and geneticinstability theoryFaulty assessment of nutrition to thecell4 Mano-vyaharsha - enzymatictheoryDiminished mental functions5 Ayu anuvrutti and Neuroendocrinetheory.Responsible for growth,development and senescence6 Vighata and Disposable somatheoryPhysical and Mental stress7 Matra ahara and Caloric restrictiontheory (Rate of living theory)lowers the level of oxidative stress8 Rasa shoshana andDysdifferentiation theoryProduction of inefficient cells.9 Dhatu asamata and somaticmutation theory Unusual changes occurring in the cellOther protein i.e. collagen changes,10 Agni asamata and free radicaltheory, Error catastrophe theory.Metabolic impairment11 Dhatus and Agni asamata and crosslinkersCellular, enzymatic, etc. changes12 Ojokshaya and immunologic theory Susceptibility to disease and death.Kala (time factor)Jara is a phase of life that occurs by the effect of kala i.e. time factor. Modernscientists also agree with the influence of time factor on ageing progress. They opinethat ageing is a process of unfavorable progressive change usually correlated with thepassage of time, becoming apparent after maturity and terminating invariably in death
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   161  of the individual. The definition of “Ageing” shows effect of kala. Ageing is definedas, the gradual structural changes that occur with the passage of time, that are not dueto disease or accident and that eventually lead to death. (D.P.M. Dictionary).Thus the Kala, which cannot be stopped at any cost, is an important cause of AgeingProcess. After reaching certain phase, Ageing Process (here degenerative process)starts which may be slow or fast depending upon the environment, habits, diet andother allied factors of an individual.Swabhava and VataThe invisible nature’s unique process can be called as Swabhava. The process ofdeterioration occurs naturally.Kalyana Bagchi - president, Society for Gerentological research, New Delhi, opinesthat scientists of various disciplines agree that ageing is a biological process exactlylike what happens when a small, invisible to the naked eye, the fertilized ovum goeson multiplying rapidly and in a matter of 270 days produces a human individual. Thisis nature’s unique process known as morphogenesis and is characterized bymultiplication and specialization of cells and marked by growth. Ageing is abiological process but with a big difference, in this phase the growth of cells and itsreplacement slows down and gradually pass into senescence.For the sustenance of life, all the Dosha, Dhatu and Mala should be in equilibrium.For that, Vata is needed which dominates the formation of total body structure andfunctions. Vata acts not only at microscopic cellular level but also at macroscopicorganic level. The body tissues are very minute and innumerable. Their union anddisunion are under the control of Vata as well as Svabhava (natural property) tocombine or separate.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   162  From the explanation it is clear that, the process of growth and senescence are(Swabhavika) natural and vata is the natures functional unit.Shareera Vruddhikara bhava - abhava (Depletion of Growth Factors)Human life span can be broadly divided into 2 phases i.e. growth and senescence.Charaka Samhita mentioned 4 factors the presence of which represents the growth,where as the absence representing the senescence. Those are as follows. Kala yoga (time bounded phenomenon) Swabhava samsiddhi (Natural factor) Ahara sousthava (diet) Avighata (avoiding physical and mental stress)Kala yoga (time bounded phenomenon)Chakrapani says that, upto the age of 17, the youth phase itself is the time boundedfactor i.e. kalayoga, which enables the body to attain growth. Contemporary sciencesVAYU AND SWABHAVAParamanu Samyoga  Sharirarambha   Shariranasha (Anabolism)   (Catabolism) Paramanu Viyoga Garbh Bala Yuva Vrudha Mrutyu
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   163  also agree that the fully grown adult stage is reached between 20-25 years; most of thefunction reaches peak activity at this stage. This is followed by senescence whenvarious functions begin to decline. Hence, the growth and senescence are theresultants of the kalayoga, i.e. Time bounded phenomenon.Swabhava Samsiddhi: -The invisible nature’s unique process which is responsiblefactor for both growth and senescence of the body.Ahara sousthava (Diet factor): - Diet is possibly the most important factor incontrolling the ageing process and even in its onset.Charaka opines that ahara sousthava /ahara sampat (qualitative aspect of food) isresponsible for the proper growth and development of the body. The matra hara(quantitative aspect of food and caloric limitation) is responsible for healthy ageing(sukhayu) and longevity (Dheergayu). It can be assumed that opposite to the abovediet, produces pathological ageing (dukhayu) and shortens the span of life (alpayu).Avighata (Avoiding physical and mental stress)Chakrapani says that for the proper growth and development it is necessary toavoid physical and mental stress.Thomas B.L. Kirkwood and Steven N. Austad, says that, according to the disposablesoma theory "effective somatic maintenance is required only to keep the organism insound physiological condition for as long as it has a reasonable chance of survival inthe world. Hence it can be summarized that Avighata may helpful in achievinglongevity and Vighata (stress) is responsible for Akalaja Jara.From the above explanation, it can be summarized that, Swabhava, kala, vata andshareera vruddhikara bhava abhava are the factors responsible for Jara (ageing).
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   164  Sahaja theorySahaja theory seems to be similar to that of programmed ageing theory as explainedby modern medical science. It suggests that ageing as a pre-determined presumablygenetic, age-related alteration in cellular function that leads to susceptibility to diseaseand death.Oja kshayaOja is responsible for shareera sthairya i.e. compactness of body elements byproviding adequate nutritional defense against body elements, Oja will be nourishedby Anna rasa (nutrients). In old age agnikshaya, dhatu kshaya and errors in nourishingelements leads to the state of ojokshaya ie., inadequate nutritional defuse against bodyelements, that leads to the molecular cellular injury to cells, exceeds their repaircapacity this further accelerating the ageing process ultimately ending in death.DISCUSSION ON JARA LAXANASThe lakshanas (signs & symptoms) which are mentioned in Ayurvedic classics forJara (old age), is represented by the individual systems of contemporary science.1. Respiratory system – Kasa, shwasa, sleshma singhanodeerana2. Cardiovascular system – Vidahyate Rakta,3. Gastrointestinal tract – Agnisada4. Musculoskeletal system – Shlatha asara mamsa asthi sandhi, avanam kayasya,vimuchyate sandhaya, na sandhiyate asthishu majja5. Immune system- ojus kshaya, sarvakriya asamarthata, glani, sada, Roganmadhishtan bhutam.6. Endocrine system – Heeyamana pourusha7. Reproductive system – Shukra na pravartat, Rajonivrutti, Klaibya.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   165  8. Nervous system – Heeyamana Indriya, grahana, Dharana, Smarana, vachanavijnyana, parakrama, vepathu, nashta smruti, buddhi.9. Skin- Twak parushya, vali, nashta chaya.DISCUSSION ON EFFECT OF AGEING ON BODYEffect of ageing on dhatu (body tissue)Rasa and RaktaRasa and Rakta are 2 major Drava dhatus. Diminution of Drava, Snigdha andChala qualities of Rasadhatu, results in diminution in its functions like Jeevana,Tarpana and Dharana i.e. nourishment and support to the tissues. Clinicalmanifestation can be assessed with the help of Rasakshaya lakshana.Depletion of Drava, Raga, Spandana qualities of Rakta results in diminution in itsfunctions like Varnaprasadana (complexion), Mamsapusthi (nourishments to musculartissue) and Jeevana (tissue oxygenation). Assessment can be made with the help ofRaktakshaya lakshana as well as depletion in Rakta sarata.Contemporary medical science opines that the blood volume falls with age, and thereis a slight decline in hemoglobin concentration, more evident in women than in men.The structure and composition of red blood cells and dynamics of hematopoiesisremains unaltered. The white cell count falls slightly, the principal decrease being inthe lymphocyte count, but the platelet count and platelet functions are unaltered. Theconcentration of major electrolytes are unaffected by age except for a tendency for themean serum calcium to decline. There is a very small reduction in serum albuminconcentration in healthy elderly people which is not clinically significant.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   166  Effects of Ageing on Hrudaya (heart)Hrudaya is the seat of Rasa dhatu and the Rasakshaya lakshana like hrudrava, hrudayaspandana (palpitation), alpachesta leading to shrama and hrudayapeeda are indicativeof its effects on hrudaya.It can be inferred that some of the functions of Rakta like dhatu Poorana (tissuenourishment) Jeevana (tissue oxygenation) and spandana (rhythm) are directlydepends on the pumping mechanism of heart and any abnormality in this mechanismmay alter above said functions of Rakta.According to contemporary science, as we age, the walls of the LV thicken; theenlargement reduces the ability of the heart to pump large volume of blood to thebody. Three measures of cardiac fitness decline as a result.1. Stroke volume diminishes - as less blood goes through, this number goes down2. Cardiac output decreases - The stroke volume is diminished in older hearts,reducing total cardiac output per unit time.3. Oxygen consumption declines - As the output decline, so does the ability oftissues to be fed.Effects of Ageing on Sira (blood vessel)Siras are the upadhatus of Rakta and their nourishment depends on the Rakta dhatu,sira shaithilya, a condition mentioned under Rakta kshaya. Charaka Samhita hasmentioned the siraakunchana (hardening of blood vessels) and poorna (dilatation ofveins) under siragata vata.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   167  Contemporary medical science opines that - human arteries thicken as the year go by.This occurs primarily because of increased collagen and calcium deposition in regionsoutside the lumen. This thickening results in decreased elasticity. As a result, thevessel is less able to accumulate increase in blood flow during normal bearing andperiods of exercise. As we age the valves of veins also performs their jobs lessefficiently. This results in the condition known as varicose vein.Mamsa Dhatu (Muscular tissue)Good build musculature is indicative of strength and stamina of a person to work.Ashtanga Sangraha mentions that - as we age diminution in mamsa dhatu results in‘Shlatha asara mamsata’ i.e. flaccidity in muscles which results in diminution ofabove said functions of muscular tissue. According to contemporary medical science,the gradual atrophy of the muscle cells with age is remarkable feature of thisbiological process. The muscle which are affected first are small muscles and the bigmuscles responsible for manual work get affected much later resulting in decrease inlean body mass, muscle leading to functional impairment.Meda dhatuThe main function of Meda is snehana. As we age decline in the compactness ofMeda may result in diminution of Varna (complexion), swara (voice), netra (eye).Keshaloma (body hair), Nakha (nails), ostha (lips), mootra (urine) and pureesha(feaces) snigdhata.Asthi - Majja (Bone and marrow tissue)The main function of asthi is Dharana i.e. supporting the body. Majja dhatu provides- snehana to asthi dhatu. As we age provocation of vata results in diminution of Asthi
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   168  and Majja dhatu. It can be assessed with the help of asthi, majja kshaya lakshana anddepletion in the asthi and majja sarata.Contemporary Medical Science also opines that with advance in age, the lossof bone salt from the bones continues but the process of replacement of the bone saltis gradually reduced. As a result, the bones become porous, a condition known asosteoporosis. This porous bone is extremely fragile and this accounts for the factsthat an elderly individual even with a slight fall breaks hip or thigh bone.Shlatha - Asara - sandhi (Flabbiness of joints)Shleshaka sleshma provides nourishment and compactness to the joints. As we ageprovocation and accumulation of vata in joints resulting in degenerative changes injoints by wear and tear mechanism as shleshaka sleshma attains shoshana whichinturn results in sandhi shaithilya i.e. flabbiness of joints this condition is consideredas Sandhigata vata in Ayurvedic classics.According to contemporary science, in synovial or weight bearing joints, the calcifiedlayers of articular cartilage become thinner. Hypertrophic arthritis is believed to bephysiological in old age. Ageing results in gradual loss of cartilaginous tissue androughening of the bone ends. Osteo-arthritis is commonest manifestation of aged.Osteophytes are commonly found. The cartilaginous matrix is made up of collagen ina ground substance mainly composed of glycosaminoglycans (GAG). This GAG ismade up of chondroitiin sulphate by half, which decreases in amount with ageing.Functionally, joint lose mobility as age increases. Arthritic diseases, some of themost common expressions of joint ageing, are among the most frequent anddebilitating diseases of old age.Shukra (Diminution of Fertility)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   169  The main function of Shukra is garbhotpadana (fertility). Charaka Samhitaexplained “Klaibyam Jara sambhavam” (ageing brings the infertility) and it reducesthe sexual power of an individual. In male, declining reproductive function is muchsubtle than in females. At about age of mid fifties, decline in testosterone synthesisleads to less muscle strength, fewer viable sperm and decreased sexual desire.Palitya (White hairs)Dalhana explains that palitya means – “kesha shuklatwa” i.e. white hairs. Thenormal texture is complexion of hair is the feature of twacha Sara i.e. compact skin.Hence diminution in twachasara may result in palitya. According to contemporaryMedical science, the ageing process affects group of cells within the hair follicles.One of these groups manufacture hair shaft proteins (germ centers) and another groupof cells manufacture proteins involved in hair colour (melanocytes). The selectiveand progressive deactivation of melanocytes results in graying and whitening of hairs.Khalitya (Hair loss / Baldness)Compact skin represents the beauty of hair. Romadharana is the function ofsweda. Kesha are the upadhatus of asthi hence their nourishment depends onAsthidhatu. Diminution in above all as an effect of ageing may results in khalitya.According to contemporary medical science, as we age, the cells that manufactureshair protein, the germ centers, are selectively destroyed or deactivated when theoccupied hair is shed in affected follicles, no replacement occurs resulting in hair loss.Pattern bolding results in a change of hair manufacturing instructions. The germcenters create fine, short, white vellus hair, instead of coarse, long, original hair,because of the composition of vellus hair, the scalp appears bald.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   170  Agnisada (Digestion and Metabolism)Charaka Samhita explains that, proper digestion and metabolism of foodyields longevity. Kledaka kapha and Pachaka pitta these factors are responsible forthe proper digestion and metabolism of food. But in old age provocation of Vatadiminishes the functions of Kledaka kapha and Pachaka pitta results in diminution ofAgni (digestive and metabolic activity).Contemporary science also opines that, with increase of age, stomach becomessmaller in capacity which reduces the quantity of food intake. Gastric atrophybecomes increasingly common as age advances. There is lesser secretion of digestiveenzymes and hydrochloride acid which leads to inadequate digestion, delayedemptying of partially digested food into intestines giving various types of gastricdisorders. Minor atrophic changes in the mucosa of the small bowel are described andthere is impairment of absorption of some nutrients, this is rarely of clinicalsignificance but calcium absorption is reduced because of diminished sensibility tovitamin D.Marutodreka (Provocation of Vata)The features of provocated vata like Malasanga (constipation) and Nidranasha(insomnia) as explained by Sushruta are commonly found with aged individuals.1. Mala Sanga (Constipation)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   171  Kruchrapureeshata (constipated bowel habits) is a feature of Pakwashayagatavata. Hence the effect of ageing on Pakwashaya (large bowel) i.e. accumulationof provocated vata in Pakwashaya may be considered as responsible factor ofconstipation. Contemporary medicine also opines that reduction in the motility of thelarge bowel is common and may partly reflect diverticular disease or chronicpurgative abuse (constipation).2. Nidra Nasha (Insomnia)Tamas and kapha dosha are the responsible factors for Nidra (sleep) asexplained by Sharangadhara. Chakrapani explains that old age and predominance ofvata are responsible for Nidranasha. Hence it is clear that in aged provocation of vataby diminishing the tama and kapha results in Nidranasha (insomnia).Contemporary science opines that, age has profound impact on sleep stateorganisation. Slow wave sleep is most intense and prominent during childhooddecreasing sharply at puberty and across the 2nd and 3rd decade of life. After age 30,there is progressive, almost linear decline in the amount of slow wave sleep,decreased stage 4 sleep results in early wakening insomnia.Kasa Shwasa (Respiratory Changes)Sushruta Samhita explains that, kasa, shwasa in aged individual’s results as anupadrava (complication) of ongoing cellular senescence. Hence, kasa-shwasa,sleshma singhana udeerana are the features indicative of effect of ageing onpranavaha Srotas (Respiratory system).
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   172  Contemporary science opines that, these changes in lung function reflectespecially a decrease in elasticity of the lungs and in respiratory muscular strength.The respiratory function changes with age i.e. the total lung volume does not alter, butvital capacity falls and residual volume increases with age, so that over the age ofabout 60 the critical closing volume exceeds the functional residual volume.Ventilatory capacity falls with age, at a slower rate in non smokers than smokers.Ventilation perfusion in equality increases slightly, by probably mainly as a result ofincreasing inequality of ventilation.Heeyamana IndriyaIt means deterioration of the functions of both sensory & motor organs i.e.,Sarvendriya.Charaka Samhita explains that Indriya Samprapti is all sensory perceptions aremaintained normally when vata will be under normal status. Indriya Upaghata i.e.deterioration of sense organs is the function of provocated vata. Sushruta Samhitaexplains that when provocated vata lodges in the sensory organs like - eye, ear, nose,tongue, skin results in destruction of these sense organs. This is considered as Indriyagatavata.One of the effects of Ageing on the nervous system is loss of neurons. This is aconsequence of the Ageing Process. Associated with this decline, there is a decreasedcapacity for sending nerve impulses to and from the brain so that processing ofinformation diminishes. Conduction velocity decreases, voluntary motor movementsslow down and reflex times increase. Degenerative changes and disease statesinvolving the sense organs can alter vision, hearing, taste, smell and touch.Eyes - Timira is considered as one of the Nanatmaja vata vyadhi. As an individualgrows older, the lens grows larger and thicker and becomes far less elastic, partly
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   173  because of progressive denaturation of the lens proteins. Therefore, the ability of thelens to change shape progressively decreases with age. The power of accommodationdecreases as low as zero diopters at age seventy years from about 14 diopters in thechildhood. Thereafter, the lens remains almost totally nonaccomodating, a conditioncalled Presbyopia.Ear – Badhirya, Uccheshruti are considered as Vata Nanatmaja vyadhi. As we agedue to changes in certain proteins and due to loss of sweat glands, the canal also getsdried. This leads to a crusty build up of ear wax which can severely affect hearing.The ear drum becomes thinner and more flaccid with age and atrophy occurs inmuscles which normally support the membrane. As a result the ear drum is less easilyvibrated by sound waves. The joints of 3 ossicles begins to degenerate as we age,ligaments and muscles follow normal ageing patterns. Calcification occurs betweenthe bones, these changes result in a less efficient transfer of vibrations from the eardrum to the inner ear. The above effects result in decreased high frequency acuity anddeafness.Taste (Tongue)Rasabodhana is experience of taste is carried out by bodhaka kapha. Provocation andaccumulation of vata in Rasanendriya and diminution of bodhaka kapha results inimpairment of taste. According to contemporary science taste buds on the tongueundergo atrophy and structural changes, which lead to change in taste threshold.Some common e.g. are that elderly people need more of sugar to feel the taste ofsweetness and some need more of salt to feel the food being sufficiently salty.Smell (Nose)
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   174  Nasa hundana (diminution of sense of olfaction) one of the feature of provocated vata,as explained by Charaka Samhita. According to contemporary science exactly howthis sense ages is not known, our ability to discriminate odors remain fairly constantthrough age. After this time there is some loss but the amount varies widely betweenindividuals.Twak: -Twak parushata and Vali are the features of Jara; Dalhana explains that valimeans - Twak sankocha i.e. Skin wrinkles, which indicates the diminution of twachaSara (compactness of skin). Contemporary science also opines the same, Ageingprocess affects all 3 layers of human skin of which thinning of epidermis results inwrinkles. Although the skin is constantly ageing, pronounced effects do not occuruntil a person reaches the late forties. Around that time, collagen fibers decrease innumber, stiffen, break apart and form into a shapeless, matted angle. Elastic fiberslose some of their elasticity, thicken into clumps and fray and the skin forms crevicesand furrows known as Vali (wrinkles). There is a decrease in the number offunctioning melanocytes, resulting in gray hair and atypical skin pigmentation.Chavi: - Pigmentation of the skin is due to melanin fed into the basal keratinocyterather than that stored within the melanocytes. Skin color is partly due to the amountand activity of the melanocytes and partly a reflection of how melanin is stored andprocessed in the keratinocytes. A decline in the number of sweat glands means thatelderly patients experience difficulty in regulating their temperature in warm weather.Karmendriya1. Vak: -Speech (Vak) is less affected in the aged unless and until greater CNSpathology occurs. However, phonation and pitch of the voice are affected in
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   175  varying degrees among the older people. Slowness in the articulation of speechmay leave an impression of dysarthria in the aged.2. Pani and Pada: - Extremities (Pani and Pada) are the chief organs forlocomotion, posture and movements. The slowness in movements is mainly due todiminished strength in the skeletal muscles, reduced tone and gonadal steroiddeficiency.3. Payu: - The evacuatory organs (Payu) comprise rectum and bladder are often thevictims of ageing pathology. Sluggish bowel movements leading to constipation,incontinence of faeces and urine due to reduced tone of sphincters are wellacknowledged. These signs may sometimes also be associated with degenerativechanges in CNS. Hesitancy for evacuation is commonly seen among agedindividuals.4. Upastha: -Considerable downfall in gonadal endocrinal activity leads to lack oflibido, sexual drive and penile erection in male and menopause and vaginalatrophy in women. In addition, reduced tone in pelvic musculature in women andprostatic hypertrophy also add to the hampered reproductive system in the aged.Thus, on going through the above details pertaining to Karmendriya andGyanendriya, it is obvious that Indriya hani does occur in the old age with varyingdegrees.Effect of Jara on MindCharaka Samhita explains that, the provocated vata results in "Mano-vyaharsha" i.e.impaired mental function. The psychological effect of ageing are diminution ofGrahana (power of understanding), Dharana (retention) Smarana (memory) and
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   176  diminution of Utsaha (depression or lack of enthusiasm), Parakrama the Manobala(mental strength).According to contemporary science it is not understood, even now how brainmediates thought process, creativity, and memory. Pathologists have fully confirmedthat with increasing age, the brain becomes smaller in size and increses in weight.The brain cells in the grey cortex which are functional part of the brain becomes lessin number along with less number dendrites which carry impulses to and from thebrain responsible for the formation of chemical substances which transmits neuronimpulse from the brain to periphery thus stops the formation of it.Forgetfulness is the earliest manifestations of brain dysfunction Initialsymptoms often are difficulty with manageing money, driving, shopping, followinginstructions. More severe forms are various types of dementia, the most severe formbeing the Alzheimers disease. The effect of AChE (acetylcholine esterase) whichmaintains the level of AC (Acetyl Choline) decreases in old age. Such a qualitativechange in the enzyme of brain may account for the decrease in its functions likelearning and memory in old age.Memory loss is frequently observed in individuals over eighty-five and it isthe most common and important cognitive ability that is lost. Other mental facultiesmay also be affected such as attention, judgment, comprehension, orientation,learning, calculation, problem solving, mood and behavior.Hence it has been very rightly described as a “condition where the mind goes beforethe body".Pourusha and Parakrama
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   177  Sushruta Samhita while explaining the normal strength of a person explains itas a well built musculature along with normal physical and mental activities. FurtherChakrapani opines that i.e. "Pourusham shareerabalam, Parakramastu Manasa balam"i.e. pourusha is physical strength and parakrama is mental strength.It has been noted that there is a marked progressive decline in overall testperformance as related to increasing age. Efficiency of performance and tasksinvolving the relinquishing of old habits are found to be difficult for old people. Thereis decrease in aggression and physical performance.Lansing, in his book Cow dry’s Problems of Ageing has noted that in subjectsabove forty years there is a marked progressive decline in overall test performances asrelated to increasing age. There is a progressive restriction in forming new interests;reduction in new learning and conceptual thinking becomes progressively simplified.As the age progresses diminution of physical and mental strength, this willresults in inability to attend his daily routine, which represents,Sarvakriyaswasamarthata.CHIKITSA:AHARA (Diet)Charaka opines that ahara sousthava /ahara sampat (qualitative aspect of food)is responsible for the proper growth and development of the body. The Matra ahara(quantitative aspect of food and caloric limitation) is responsible for healthy ageing(sukhayu) and longevity (Dheergayu). It can be assumed that opposite to the abovediet, produces pathological ageing (dukhayu) and shortens the span of life (alpayu).
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   178  Diet is possibly the most important factor in controlling the ageing process andeven in its onset. An old proverb says: “we are what we eat”. Research has shownthat there is a strong connection between foods and Ageing.Numerous studies throughout the world are bringing a large number offindings which indicate that nutrition possibly holds an important key to the solutionof the riddles of ageing. Recently, the studies conducted on micronutrients, dietresponsible for chronic clinical disorder and caloric restrictions are as follows.MicronutrientsThe micronutrients like - selenium and zinc, vitamin - A, C & E, provitamins like -Beta-carotene, Lycopene, commonly found in vegetables and fruits known asantioxidants have been found helpful in keeping the elderly healthy and even in theonset and progression of ageing process.Diet Responsible for Chronic Clinical DisordersDiet, like saturated fats, fried foods, food containing large amount of cholesterol, redmeat with saturated fat etc. have been found to be responsible not only for producingchronic clinical disorders but also for the process of ageing.Caloric RestrictionThe amount of oxidative damage increases as an organism ages and is postulated to bea major causal factor of senescence. Caloric restriction - lowers the level of oxidativestress and damages retards age associated changes and extends the maximum life spanin mammals. Caloric restriction reduces the age associated accumulation of oxidativedamaged proteins, lipids and DNA, it also prevents many of the changes in geneexpression and transcription factors activity that normally occur with ageing.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   179  “Make food your ally, not your enemy to have a better chance of beating Ageing”.Hence it can be summarized that, the diet has got definite role in the process ofageing, longevity and healthy ageing. The concept of aharasampat speaks out thequalitative aspects of diet which includes the micronutrients (antioxidants) etc. andmatrahara which speaks about the quantitative aspect of food in which caloricrestriction can be included.VIHARA (lifestyle)From centuries, Ayurveda has been emphasizing the regulation of factors in terms ofDincharya, Rutucarya, Sadvritta, and other aspects of Swasthavritta for healthy lifeexpectancy. While describing the types of Jara Sushruta Samhita given reason forAkala Jara as “Aparirakshankrita Akalaja” here the word Aparirakshankrita meansthose who have not followed the Dincharya (Daily regimen), Rutucarya (Seasonalregimen), properly, and did not undertake Shodhana at proper time and proper way.Dincharya is described in such a way that the adverse changes in the Dosha, Dhatusetc. may be made reversible or minimized as per circadian rhythm. If one follow therules of Swasthavritta (Daily and seasonal routine for health) then Dhatus (tissues)remains in healthy condition, thus there will be no disease. In this way the tissues willgrow or regenerate in proper manner which result in delaying the Jara. From theabove observation it may be said that remaining of bodily tissues in the healthycondition delay the ageing.Importance of Rutushodhana
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   180  We know that all the cells of the body are supplied with information and nutrientsthrough certain channels. The key nutrient channels are capillaries. Thus leadinginvestigations today are convinced that “We are as old as our capillaries”. The use ofcapillary microscope displays the “drying of the capillaries” with age.“Why we old?” Because we fail to throw off the waste products set free by our cells.Because we fail to keep our system clean, our arteries harden because of the depositsleft in them. Our cells dry up because their pores become so clogged with waste thatthey can no longer absorb the life giving substances around them.If we can keep these pathways (Srotas) open and elastic by taking Shodhanaaccording to Rutu, definitely we can prevent the Akala Jara and Delay Kalaja Jara.According to Dr. Deepak Chopra, author of “Ageless Body Timeless Mind”, a personsage is a mixture of three different ages: Chronological (actual age), Biological andPsychological. While the first age cannot be changed, on the others two it is up to theindividual how they influence them. The Biological Age is given by the state of ourbody. In 2005, Biotechnology and Biological Sciences Research Council (BBSRC)has presented some interesting research at Edinburgh International Science Festival:an active person in his/her 80s can have the muscle strength of a much youngerperson who is sedentary (inactive). UK experts agree also on the fact that the diet (orsupplements) rich in essential amino acids and compound proteins can help strengthenthe muscles (after 40 years of age a person starts loosing between 0.5- 2% of themuscle). The Psychological Age depends a lot on the lifes experiences and ourattitude toward them. If we are depressed, if we think negative about one, if we areoverwhelmed by the day-to-day worries, if we forget to smile, laugh and enjoyourselves than we will definitely accelerate the Ageing Process.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   181  R.N. College in his "principles of geriatric medicine" - opines that, it is important toappreciate that some features of ageing are age determined, that is, they are inevitablewhile others are age related, that is they result from an accumulation of factors such aslack of exercise or poor diet or are accelerated by habits such as cigarette smoking,heavy alcohol consumption or over exposure to sun light.In conclusion, it can be pointed-out that, there is strong role of Ahara (diet factor) andVihara (healthy life style) in preventing Akala Jara and delaying Kalaja Jara.Achara RasayanaAchara Rasayana acts as Rasayana in 3 dimensions, Improving the personality, Improving the Social relationship, Improving the physical health by maintaining the normal state of mind.RASAYANARasayana specially deals with the science of nutrition, Geriatric care andRejuvenation. Rasayana signifies not a single drug or medication rather refers to arejuvenative regimen which of courses uses rejuvenative remedies or drugs, dieticsand overall healthy life-style and positive psychosocial conduct.Different definitions of Rasayana are given in classics. But, their ultimate view is oneand the same i.e., nutrients traverse through different Srotas to tissue elements,replenish them, thus enhancing total body strength and maintain youthfulness to alonger duration.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   182  The use of Rasayana measures and remedies produces best qualities of dhatus, i.e.body-tissues by acting through one or all of the following three principal levels ofbiological system with net result of improved nutritional status leading in turn tobetter qualities of tissues, longevity, resistance against disease and improved mentalfaculties. The primary levels/modes of Rasayana effect are:1. At the level of Rasa (promoting nutrient value of plasma)2. At the level of Agni (Responsible for digestion and metabolism)3. At the level of Srotas (Promoting microcirculation and tissue perfusion)Various types of Rasayanas are mentioned in classics. They keep the body healthy bypreventing the onset of disease, promoting the healthy status and curing the alreadymanifested disorders.Besides the above mentioned three generic modes of action of Rasayana, someRasayana are organ and tissue specific and used for specific indications like MedhyaRasayana as brain tonics, Hridya Rasayana as cardiotonics, and so on.Rasayana has a definite targeted effect of healthy tissue generation. The word used bythe Acharyas for healthy tissue is “Shasta Dhatu”. It is clearly indicates that theancient scholars were fully aware of the fact that the ageing process is a result ofdamage to the organs, tissues, cells etc. of the body. Repair of the damaged part onone side and generation of healthy parts on the other side is the only way ofcombating the ageing process. Apart from the healthy life-style and adequateregulation of diet quite a number of herbal and herbo-meneral drugs are used asRasayana drugs. Specific formulations are advocated for arresting or prolonging theageing process or combating the old age diseases.Dhatu (tissue) targeted therapies.e.g.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   183   Blood – Musta, Patola, Katuki, Muscle – Nimba, Triphala, Kutaja, Bone – Guduchi, Chandana, Asthishrankhala Nervous system – Brahmi, Shakhapushpi, Vacha Digestive tract – Adraka, GajapippaliSome Rasayanas are disease specific and are used in specific disease status as theyinduce specific bio-strength to combat a particular disease. Such Rasayana are calledNaimittika Rasayana. The classical Naimittika Rasayanas are Shilajatu for Diabetesand Tuvaraka for skin diseases.Some Rasayana are age specific and can be prescribed for particular age groups. Asstated earlier Ayurveda describes the decade wise ageing process, during the processof ageing an individual goes on loosing the age-related qualities and if this loss iscompensated by age-specific Rasayana in specific age groups the rate of ageing canbe retarded to some extent and one can promote longevity.1. It helps to normalize the programmed cell death and hence is a sure treatmentagainst both degenerative diseases.2. All Rasayana Aushadhas are Agnideepana in action and hence it counters loss ofappetite helps to improve digestion and metabolism.3. Rasayana drugs act at the level of Dhatus and are the treatment of choice in ageingprocess and degeneration.4. By Rasayana, one can check Kala Mrtyu, Aristha Lakshana, Jarajanya Rogas andJanapadoddhwamsa Vyadhis. These, actually, are made possible not only due toRasayana but also due to Japa, Tapa, etc. along with that.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   184  RasoushadhiAnti –Oxidation by Metals in Neuro-Degenerative Disorders:The metallic value in body is very less but they had active participation incounteracting of free radicals which are caused by Oxidation. Certain areas of Braine.g. Globus pallidus and substantia nigra often contain high amount of Iron. It istherefore not surprising that Antioxidant supplement have been successfully used toimprove the functioning of the brain in people who are ageing normally as well asperson suffering from neurodegenerative disease such as Stroke, Alzheimer’s andParkinson’s disease etc.Mode of action of RasayanaRASAYANAImmunity AgniRasa Srotas Improved NutritionFormation of best quality of Dhatus i.e. Body Tissues Longevity  Mental Competence Rejuvenative State of Mind-Body SystemrÉ‹UÉurÉÉÍkÉlÉÉzÉlÉÇ iÉSè UxÉÉrÉlÉqÉç | (zÉÉ.) sÉÉpÉÉåmÉÉrÉÉå ÌWû zÉxiÉÉlÉÉÇ UxÉÉSÏlÉÉÇ UxÉÉrÉlÉqÉç
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   185  Jara chikitsaThe biological stimulation of Vata Dosha can be delayed by Rasayana treatmentparticularly comprising of Vayasthapana drugs. The persistent treatment of Rasayanaeven after the onset of premature ageing will keep up the qualities of Dhatu; inhibitKshaya apparently guarding the Dhatvagni, this delays the ageing process. The usageof Vatashamana drugs provides optimum control over vataja activity which is theproduct of vicious senile process out of Dhatukshaya. The use of Basti which is“Vayasthapana” is of vital importance in old age. It is not possible to reverse theageing process completely but if proper care is taken, the damage and changes thatoccur with due course of time may be stopped up to certain level. It develops thepositive health, mental faculties and imparts the resistance and immunity against thediseases by keeping the excellence in the tissues.SIDDHANTIKA BACKGROUND FOR CONCEPT OF JARA1. Kshana bhangura vada(theory of impermanence)Theory of kshanabhangura or theory of impermanence is an important theory inboudha darshana. According to this theory everything of this universe is not static andeternal. Instead everything is momentary and everything is produced in the firstmoment, exists in second moment and gets destructed in the next moment.Boudha darshana further states that some cause is there for creation of matter. Butthere is no such cause for its destruction. Destruction is natural. The human life is alsomomentary like a bubble of water (eÉÏÌuÉiÉ oÉѯoÉÑS mÉëÉrÉqÉç) which lasts only for a moment.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   186  zÉÏrÉïiÉå AlÉålÉ CÌiÉ zÉUÏUqÉç | The definition of Sharira directly indicates the catabolicactivity occurring in the body.2. Swabhavoparama vada (theory of natural destruction)It is important and specific theory of ayurvada and one of the fundamental principlesof Ayurveda treatment.The term swabhavoparama is the conjunction of two words swabhava and uparama.Swabhava means natural or without seeking any cause. Uparama means destruction.The meaning of swabhavoparama vada is natural destruction without seeking anycause.In this way the sharirika dhatu in the body also get destructed and transformed inevery moment. There is no specific cause for the existence of transformation anddestruction.If it is seen scientifically, it can be concluded briefly that the wear and tear(production and destruction) phenomenon goes on for ever in the body. Ahara is causefor wear (production) phenomena. But tear phenomena i.e. uparama (destruction isnatural) the R B C in the blood which is produced through the ahara, gets destructednaturally in 120 days. It means swabhava uparama (natural destruction of the bodytissue) is one of the cause for Jara process.3. Parinama vada(theory of transformaion)MüÉsÉxrÉ mÉËUhÉÉqÉålÉ eÉUÉqÉ×irÉÑÌlÉÍqɨÉeÉÉ || C. Sha 1/115When an object changes its original form and gets transformed into another form it iscalled parinama. Parinama vada was postulated by Sankhya philosophers. Based onthis parinama vada they described the evolution process of universe.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   187  Charaka saamhita states that influence of time (MüÉsÉ) is cause for the changes in thebody i.e oÉÉsÉ to rÉÑuÉÉ, rÉÑuÉÉ to mÉëÉæRû and lastly uÉ×® (eÉUÉ)This is called as tramsformation due to change in age.“xÉiÉÉå ÌWû AuÉxjÉÉliÉUaÉqÉlÉqÉåuÉ eÉlqÉ”It means atma to garbha, garbha to baalya, baaalya to youvana, and youvana to jaraparinama takes place.4. Swabhava vadaDifferent darshanas have accepted swabhava as a cause in the form of pratitantraSiddhanta. But it is the fundamental principle of charvaka darshana. In Ayurvedicclassics jara is considered as swabhavika vyadhis.5. Kala vadaKala is god. It is created by itself. It is the instrumental cause for all the products. Itcarries away all the human beings towards death i.e as birth, existence and deathdepends on kala. The concept of kala has been discussed in detail in Ayurveda. It ispresumed to influence the different aspects of living organism.Kala is unavoidable and inevitable factor and swabhava an inherent factor. Bothinfluence the physiology and pathology of all the living creatures from birth to death. Discussion on Janusandhigatavata Discussion on definition Janusandhigatavata can be defined as a disease of sandhi which occurs mainly in Jara avastha  (Old  age)  due  to  provocated  Vata  located  in  Sandhi,  with  symptoms  of Sandhishula,  Sandhishotha  etc.  In  Contemporary  science  the  similar  condition  of 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   188  joint is explained as a form of arthritis, affecting mainly in elderly people, caused by chronic degeneration of the cartilage and synovial membrane of the joints, leading to pain and stiffness.  Synonyms: Jeerna vata, Sandhigatavata, Degenerative arthritis and age relatedarthritis these synonyms from both the science (Ayurvedic and Allopathic) prove thatJanusandhigatavata appears mainly in old age.Discussion on nidanaIn Jara avastha (old age) the Nidanas of Janusandhigatavata are, Naturally aggravated Vata Dhatukshaya specifically kshaya of Mamsa, Meda, Asthi and Majja, Shlatha Asara sandhis (laxity of joints), Kshaya of sleshmadhara kala, shleshaka kapha, Peshi, Snayu, Sira, andKandara.The prevalence and incidence of Gon-arthrosis is associated with increasing age. Bothsystemic and local factors contribute to development of Gon- arthrosis.1. Systemic factors include old age, female sex, genetics, bone density andnutritional elements, which makes the cartilage more vulnerable to injury and lessefficient at repair.2. Local biochemical components, in combination with systemic factors, have asynergistic effect on the process of cartilage breakdown.3. Neuropathy: Muscle tone around a joint modulates the forces of knee joint impactloading. If proprioceptive input to the joint is impaired, abnormal muscle toneresults in Gon- arthrosis by transferring abnormal forces to the knee joints.4. Knee laxity which may be the resultant of age may increase the risk for OA.Discussion on Samprapti
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   189  Vata Dosha aggravated due to dhatukshaya flows out of its Ashaya to circulate in theentire body with its constituents. It gets localized in the Janusandhi. In the elderlypopulation Janusandhi Khavaigunya is already present, due to kshaya of sleshmadharakala, shleshaka kapha, snayu, peshi, kandara, sira which are present around the Kneejoint; because unless and until there is Khavaigunya of Srotas, the dosha will not takeAshraya. The chief qualities of Vata are Ruksha, Laghu, Khara, Vishada, andSukshma. These are exactly opposite to the qualities of Shleshaka Kapha present inSandhi i.e. Snigdha, Guru, Picchila and Mrudu. When provoked Vata gets localized inSandhi, it over powers and undoes all qualities of Kapha which lead toSandhigatavata. The chief task of Kapha is to sustain or Dharana. This function ofkapha is destroyed by the influence of aggravated Vata.Showing specific Samprapti of Janusandhigatvata JARA (OLD AGE)  Prasara of Vata in Sarva ShareeraDhatukshaya Vataprakopa Rikta Srotas in Janusandhi (Shleshaka kapha, Asthi dhatukshaya)Aggravated Vata Settles in the Rikta Srotas (Janusandhi) Dosha Dushya samoorchana
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   190     Samprapti GhatakasDosha - Vata - Vyana vata vruddhiKapha - Shleshaka kapha kshayaDushya - Saptadhatu.Sira, Snayu, Kandara,Srotas - Asthivaha, Majjavaha,Srotodushti - SangaAgni- Jatharagi - MandaBhutagni - MandaRogamarga - MadhyamaUdbhava sthana - PakwashayaAdhistana - AsthisandhiVyaktasthana - Janu SandhiOld age is associated with the following changes,1. Decreased responsiveness of chondrocytes to growth factors that stimulate repair.2. Increased laxity of ligaments (cruciate), which makes the knee joint more unstableand susceptible to injury.3. Failure of shock absorbers or protectors of the knee joint, which includesdecreases in muscle (quadriceps) strength and neurologic responses.4. Development of a thinner rim of noncalcified cartilage, which leads to anincreased shear stress at the basal cartilage.5. Increased mucopolysaccharide in articular cartilage and diminished by Hyluronicacid in synovial fluid develop in old age.Janusandhi gata vata 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   191  Knee (synovial or weight bearing Joint), the calcified layers of articular cartilagemargins become thinner. There is a proliferation of fibrous tissue at the articularmargins leading to well-defined lipping consisting of fibrocartilage, hyaline cartilageand finally bone. Osteophytes are commonly found. Hypertrophic arthritis is believedto be physiological in old age.The cartilage matrix is made up of collagen in a ground substance mainly composedof glycosaminoglycans (GAG). This GAG is made up of chondroitiin sulphate byhalf, which decreases in amount with age.Functionally, Knee joint lose mobility as age increases.Gon-arthrosis, in early stage, articular cartilage swells, due to increase of water inmatrix. This is owing to the loss of normal restraint provided by collagen fiberssurface fibrillation. The underlying bone becomes more vascular and sclerotic andremodeling takes place resulting in altered contour of articular surface.Discussion on PurvarupaGon-arthrosis is a condition that starts as mild pain, which progresses gradually.Therefore such mild pain in a susceptible individual in absence of other features maybe considered to be purva roopa. Moreover such a warning also helps in initiatingpreventive treatment to halt the progression of the disease.Discussion on RupaSandhishula: Shula is the chief symptom of prakupita vata. The Shula mentioned inCharaka Samhita refers to Shula in initial stages where pain is only on jointmovement i.e. flexion and extension, while the Shula mentioned by Sushruta Samhitaand Madhava Nidana refers to relatively late condition where the pain becomescontinuous. It also said the worst towards evening because of the tendency of vatawhich naturally aggravates at evening period, hence the Shula.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   192  The major symptom which put the patient of O.A in trouble is pain. In Gon-arthrosisactual causes of pain are not clear. Surrounding tissues probably contribute to painbecause joint cartilage has no nerve supply and when the knee is injected with localanesthetics the pain is reduced, indicating that nerve endings in the joint capsule andother surrounding tissues are affected. Although one of the causes of pain could begrowth of Osteophytes and stretching of adjacent periosteum other possible factorsinclude microfractures, synovitis and increased intraosseous pressure. Other causesfor pain may be due to medullary hypertension caused by distortion of blood flow bythickened subchondral trabeculae. Joint instability leading to stretching of the jointcapsule and muscle spasm may also be the sources of pain.Showing Source and Mechanism of pain in Gon-arthrosisSource MechanismSynovium - InflammationSubchondral bone - Medullary HTN, Micro fractureOsteophytes - Stretching of periosteal nerve endingsLigament - StretchCapsule - Inflammation and distensionMuscle - SpasmSandhishotha:Dosha Sanchaya in specific site is the main causative factor for Shotha. InJanusandhigatavata, Prakupita Vata gets enlodged in Janusandhi resulting in Shotha.Here Vatapurna Druti Sparsha type of Shotha is present. Because Shotha is Vatictype, on palpation the swelling is felt like a bag filled with air.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   193  The characteristics swelling of the Knee Joint is due to thickening byOsteophytes, Soft tissue swelling also contributes its part. In the initial stages of KneeO.A. swelling is not seen, but in later stages due to synovial inflammation may occurthis may lead to synovial effusion but it is not large, however with chronicity ofillness development of swelling too is seen to take place. However, Bakers cysts areseen in popliteal fossa which is result of seepage of synovial fluid. Sometimes thecyst ruptures and fluid is dispersed which leads to swelling of Knee Joint.Atopa:Atopa is the resultant of kshaya of shleshaka kapha in the joint, which is in state ofdecrement due to the prakupita vata, which by the virtue of Rooksha, khara, Vishadaproperties antagonize the Snigdha, Slakshna, Picchila properties of shleshaka kapha.Shleshaka kapha due to its Snigdha and Picchila guna it lubricates the joints andavoids friction on movement.OA leads to loss of cartilaginous matter between the two articular surfaces.Therefore, the absence of lubricating cushion leads to the friction between the twosurfaces leading to a peculiar sound which is the Crepitus. Crepitus is relatively alate symptom; however it may appear in early stages in a few cases, it is palpable inthe initial stages but later tends to become audible.Sandhihanti:There is complete or partial absence of movements like Prasarana and Akunchana.Because gati is unique feature of vata and in Janusandhigatavata, this gati isobstructed because of sanga type of Srotodusti. This gives rise to stambha. InMadhukosha Commentary, Commentator Vijayarakshita has given two meanings ofHanti Sandhigata. One is Sandhivislesha and another is Sthambha. Here,Sandhivislesha (shlathasandhi) occurs due to Prakupita Vata located in Sandhi.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   194  Stambha means immobility as defined by Dalhana. Arundatta explained stambha asless or loss of flexion and other movements. The prakupita vata in the sandhi due toits Sheeta, Ruksha which causes shleshaka kapha kashaya leads to loss of lubricationand thus causes “sthamba”. Ashtanga Sangraha and Ashtanga Hrudaya have stated“Prasarahakunchana apravritti” which too means the same.Stiffness is one of the features of OA which may persist for about 20 minutesor less. The stiffness occurring due to loss of cartilage and inflammation of extraarticular structures. This kind of stiffness usually occurs after a period of inactivity.Sometimes the fear of pain leads to inactivity which leads to further stiffness. Apatchy chronic synovitis and thickening of the joint capsule restrict the jointmovement. Bony out growths in the margins called Osteophytes are also responsiblefor restricted movement. However, this symptom may not to be seen in early stages.When the disease aggravates the Vitiated Vata may produce inability of movements.In allopathic science mentioned that joint deformity due to the altered line of weighttransmission this is usually progressive and damageing and it may produce a valgus(knock-knee) deformity.Discussion on sadhyasadhyataJanusandhigatavata is Yapya in old age because all the Vatavyadhis are difficult tocure and they are said as Mahagada. Madhyama Rogamarga, Situation in MarmaAsthi Sandhi, Vitiation of Asthi and Majja, Dhatukshya, Vriddhavastha also makes itKastasadhya. In Allopathic science, the scientists believe that once the diseaseOsteoarthritis has taken place, then it is very difficult to reverse or block that diseaseprocess. Till date, no treatment is available that can reverse or slow or block thedisease process. Allopathic science has only palliative treatment for Osteoarthritis.Janusandhigatavata Vs knee Osteoarthritis
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   195  The clinical features seen in both Sandhigatavata and osteoarthritis are similar. InSandhigatavata sandhi Shula is the main feature. The other features include Shotha,stabdhata and atopa. In osteoarthritis too Shula is the main presenting feature. In mostpatients difficulty in flexion and extension of the knee forms an important complaint.However Shotha (oedema) and atopa (Crepitus) form relatively later symptoms as thedisease advances.Regarding the nidanas also similarity between Sandhigatavata and osteoarthritis isclearly identified which will be enumerated in the context of nidana. In osteoarthritistoo degenerative changes are hallmark of the event of pathology and in Sandhigatavata dhatu kshaya is one of the prime factors influencing samprapthi.Discussion on chikitsa in Janusandhigatavata1. Snehana:Snehana is the first line of treatment explained in the classics for Sandhigatavata.Here Snehana refers to both bahya and abhyantara Snehana.1. Bahya Snehana in the form of Abhyanga, Seka, Janu Basti.2. Abhyantara Snehana in the form of Snehapana, Anuvasana basti, Matrabasti.Sneha Dravya possesses Drava, Sukshma, Sara, Snigdha, Manda, Mrudu and GuruProperties which are just opposite to those of Vata so it alleviates Vata. Snehana helpsin the promotion and regulation of the proper functioning of Vayu.AbhyangaThis refers to the massage with sukhoshna taila in anuloma gati.Properties:-Vatahara, pustikaraka, ayushyakaraka, Jarapaha, shramahara, abhigatasahatwa, kleshasahatwa, , nidrakaraka, dristiprasadaka.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   196  3. Mardana:-It is a variety of bahya sneha where in the application of oil is donewith pressure.4. Unmardana: - Unmardana is the type of massage in which pressure is exerted ondiseased Sandhi. It relieves Shotha and enhances blood circulation.5. Upanaha Swedana: - Swedana is the procedure which relieves Stiffness,Heaviness, and Cold. Upanaha is bandageing. The Paste should be hot and mixedwith Sneha. The application of heat causes relaxation of the muscles and tendon,improves the blood supply. It relieves pain on the affected joints.6. Bandhana: - Bandha is bandageing tightly leaves of Vatashamaka drugs onaffected Sandhi. This bandageing does not leave any scope for Vata to inflate theSandhi. In Janusandhigatavata, Shotha appears like a bag inflated with air.Bandhana causes abatement in this Shotha.7. Agnikarma: - Agnikarma on Mamsa, diseases located in Sira, Snayu and Asthiget alleviated.DISCUSSION ON MATRABASTIImportance of Matrabasti in Jara (old age) It can be administered at any time and in any season. Its action, benefits like other bastis (Niruha and Anuvasana) but it is harmless. Niruha and Anuvasana basti have some restrictions regarding diet and activitiesafter administering basti, there are no such restrictions for Matrabasti one canperform their routine work even after taking Matrabasti. Niruha and Anuvasana basti should be given alternatively but Matrabasti can beadministered continuously.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   197   The dose of Sneha in Matrabasti is very small; it retains in the body longer timethan other bastis, easily absorbed in the body and gives a very good result. Tikshna basti contraindicated in Vruddhavastha. (Su. Chi.35/21) Matrabasti can be administered in Durdala purusha whereas Sneha and Niruha arecontraindicated. Old age peoples having Alpasatva, Mandagni, Dhatukshaya and Heenabala theycannot bear large amount of sneha, so in such people matra of sneha must be lesstherefore Matrabasti is more convenient in old age peoples. Matrabasti eliminates the vitiated doshas along with Mala from the body and ithas the Brumhana, Vatahara and Balya properties, in this way it acts as Shodhanaas well as Shamana. In Jara (old age) people are more prone to Vatavyadhis; Matrabasti is the besttreatment for Jarajanya Vatavyadhis because it gives continuous Snehana(nourishment) to the body. In old age Agnimandya is present. The lesser amount of sneha in Matrabasti maybe useful in improving the Mandagni as mentioned in classic Matrabasti isalpagnisandhukshana. Anuvasana basti is contraindication in Durbalagni. e.g. ifthe fire is less in quantity dry grass or little oil can be added and fire can be mademore powerful and capable of digesting anything. On the other hand if morequantity of fuel is put into this fire, the fire may become weaker, hence theAnuvasana basti is contraindication in Durbalagni. Matrabasti is most indicated procedure in Vruddhas due to its property of balya,Vatahara, and alpagnisandhukshana.Matrabasti as Rasayana
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   198   Vatatapika Rasayana: - Matrabasti having no restrictions regarding diet andactivities after administering it and one can perform their routine work even aftertaking this basti. Ajasrika Rasayana: - Matrabasti can be taken as daily. Samshamana Rasayana: - Matrabasti is having Vatahara, Brumhana propertiesand also it gives happiness, complexion. Though Matrabasti is having less Sneha compared to Anuvasana basti, but thepotency of sneha which is using in Matrabasti can be increases by doing Samskaralike Shatapaka, Sahasrapaka.Because of all these properties of Matrabasti it has been told as “Niraapada,sarvaloukiki, sarvakaliki and Vriddha Vyavahara Siddhach” by Shivadasasen whilecommenting on Chakradatta.Discussion on Materials and MethodsDiscussion on selection of drugsIn classics it is mentioned that if Shodhana is administered before Snehabasti, it helpsin purification of Srotas and Veerya of sneha can spread easily through cleaned Srotasresulting in better absorption of sneha. The present study was on Jarajanya(Dhatukshyajanya) Janusandhigatavata hence Haritaki churna was selected. Haritakichurna is having the properties like Deepana, Pachana, and Vatanulomana and it iseasily available.Ashwagandha Ghruta having Vataghna, Vrushya, Mamsavardhana properties.Because of which it shows not only preventive but also promotive and curative effectsand also slows down Jara by breaking the pathogenesis. Godugdha and Goghrita are
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   199  having the properties like Vatanashaka, Jeevaniya, Balya, Brumhana, and Rasayana.Godugdha is also having the chemical compositions like calcium, magnesium,potassium etc.It is well known fact that ‘Taila’ is Shreshtha in Vatavyadhi, but in JarajanyaJanusandhigatavata along with Vatashamaka, Kaphavardhaka and Mamsavardhakaproperty is also very important and in Davidson Medicine it is mentioned that in kneeosteoarthritis psychological symptoms like anxiety and depression are seen. In old ageGhrita is best for snehana among four snehas as mentioned by charaka Samhita.Ghruta is having the properties of Vayashapna, Mamsavardhana etc. Hence in thisstudy Ghruta was selected for Matrabasti.Discussion on InstrumentsThere are many devices to administer basti, but in present study enema syringe andrubber catheter was selected because these are easily available and it can be used verysafely.Discussion on Inclusion criteriaIndividuals of either sex were included. The age group 60-75 years was consideredbecause the study was intended on Jarajanya Janusandhigata vata.Discussion on Exclusion criteriaThe study was intended on primary OA other conditions mimicking it were excluded.Individuals with other systemic disorders like bleeding piles etc were excluded toavoid the interference in the action of drug and also to avoid complications.Discussion on Diagnostic criteria
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   200  In Janusandhigatavata Signs and symptoms are more diagnostic than any other labinvestigations. Therefore in the study signs and symptoms such as Shula (Pain),Shotha (swelling), Atopa (Crepitus), Prasarana Akunchana aprvrutti (difficulty inflexion and extension), were primarily considered. Radiological investigations areonly supportive because it is mentioned that correlation between the symptoms andradiological investigations are poor.Assessment CriteriaWOMAC arthritis index which is an international index for assessment of arthritis inlower extremity was selected because the index clearly elicits all the symptoms of thepatient which also facilitates the easy application of statistics after grading. Thequestionnaire was easily implementable in short duration.DISCUSSION ON OBSERVATIONThus the observation was based on the clinical trials on 30 patients registeredin the study. The data thus collected were analyzed at the end of the study.Availability: -Most of the cases reported to GAMCH, OPD directly, during the camp carried out for3 month and some registered after the camp period. During the camp, patients withdifferent joint disorders too approached but they were all screened and excluded.Age: In the present study, maximum numbers of patients were of age Group 60-65years (50.0%) followed by 65-70 years age Group (26.7 %). Sandhigatavata is the
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   201  disease of Vriddhavastha due to Dhatukshya which has been found same here in thepresent study.Sex: Majority of the patients were of male sex (60%) in the present study. It occurs inFemales soon after Menopause. This has been found in the present study also 12(40%) patients. This shows the prevalence of the disease in Females after Menopauseas mentioned in texts.Religion: In this study maximum numbers of patients (96.7%) were Hindus indicatinggeographical predominance of Hindus among the selected population.Marital status: All the patients were married because all the patients treated in thisstudy were aged. Hence, any consolidated comment cannot be given because there isno specific role of marriage in development of O.A.Education: In the present study it was found that the majority of patients wereilliterate i.e., 14(46.7%) primary educated were 4(13.3%) middle schools were 6(20.0%) and graduates were 6(20%). Due to lower education people have to do thejob which is more strain full. This may lead Dhatukshya and may be cause forSandhigatavata.Occupation: In this study it was observed that majority of the patients werehousewives i.e. 12 (40.0%) followed by labor were 11(36.7%) and of business were 7(23.3%).The occupation has impact on causing Sandhigatavata and involvement ofparticular joint also depends on occupation. In the present study, maximum numbersof patients were housewives. Reason behind this may be while performing domesticwork, they have to stand for a long period and have to lift weights Also negligence ofown care is the main cause. Laborer and Business man have to work hard; this couldbe the reason for the occurrence of Sandhigatavata in these people.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   202  Socio – Economic Status: In the present study it was found that majority of thepatients belong to poor class i.e., 18(60%) followed by middle class were 11 (36.7 %)and rich was only 1 (3.3%).Poor Class people cannot afford nutritious diet and thismay be the cause for Dhatukshya and thus the disease Sandhigatavata.Habitat: In the present study it was found that the patients from rural area were morei.e., 19 (63.3%) and patients belonging to urban area were 11 (36.7%).Chronicity: In the present study it was found that 16 patients had the chronicity upto5yrs, followed by 10 patients had chronicity 6-10 yrs and 4 patients had chronicity formore than 10 yrs.The disease Sandhigatavata is encountered as a Yapya or Kastasadhya variety ofdisease under the Vatavyadhi and all the Yapya vikaras are chronic in nature. As perobservations, the chronicity of the Sandhigatavata is reflected. The chronicity isinversely proportional to the prognosis of disease i.e. if chronicity is less, prognosis isgood.Joint involvement: -All patients had bilateral involvement of joints and most had initial involvement ofright knee in history.Pattern of Onset: In this series, 96.7% patients gave history of Gradual onset whileonly 1(3.3%) patient gave history of insidious onset of the disease. Gradual slowprogression of the disease Osteoarthritis is common. Data of the present study showsthe same thing.Dietary Habit: Majority of the patients were having habit of Vishamasana (91.42%)followed by habit of Adhyasana (8.57%) Adhyasana could be the cause forSandhigatavata. It causes Agni vaishamya and Amamedavriddhi thus leading toAvaranjanya Sandhigatavata.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   203  Type of Diet: Maximum number of patients found in Vegetarian Group i.e. 21 (70%)and mixed diet were 9 (30%). No any conclusion can be drawn on this observation,because more number of Hindu in this series reflects their vegetarian diet.Agni: In this study, majority of patients were having Mandagni (65.71%) followed byVishamagni (28.57%). Mandagni may be the causative factor of Sandhigatavata.Because of Mandagni digestion does not occur properly which leads to Dhatukshyaand thus Vataprakopa resulting in Sandhigatavata.Bowel Habit: Majority of the patients were having irregular Bowel Habit (74.28%)and followed by Kathin Stool (25%). Kathin Stool indicates dominancy of Vata: Itmay obstruct the Prakrita Gati of Apana Vayu which leads Dusti of all the Vayu andAgni Also it Vitiates Purishadharakala i.e. Asthidharakala.Emotional Make– up: Majority of the patients were having normal emotional makeup (42.86%) followed by Anxiety (40%) and depression (31.43%) Anxiety anddepression may be a causative factor for Sandhigatavata as Acharya Charaka hasshown Atichinta, Atibhaya, and Atikrodha as Nidana of Vatavyadhi.Menstrual History: In this study, all female patients were having Menopause.Menopause is the important factor for the production of Osteoarthritis. As mentionedin texts, same has been found here in this study.Deha Prakriti: 6.7% patients were of Vata Prakriti and 80% patients of Vata-KaphaPrakriti. Vata-Pitta Prakriti was observed in 10% patients i.e. most of the patientswere having Vata Pradhana Dvandvaja Prakriti. Pitta-kapha prakriti 3.3% means only1 patient. Thus it can be said that Vata dominant patients suffer more fromSandhigatavata and prognosis may be poor in them as Prakriti and Dosha involved aresame.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   204  Sara: The Sara is the supreme part of the Dhatu which provides strength to that Dhatuand also provides resistance to the disease. In this study 26.7% patients had AvaraSara so absence of or less Sara especially Asthi Dhatu may be a risk factor forSandhigatavata.Samvahana: In the present study 26.7% patients found of Avara Samvahana. Itrepresents that in old age compactness of body is not good.Satva: Majority of the patients were having Madhyama Satva (80%) followed byAvara Satva (20%) Avara Satva patients show more severity of the disease.Bala and Vyayama Shakti: In this study, 70% patients were having Avara VyayamaShakti and 30% patients were having Madhyama Vyayama Shakti. Vyayama Shaktiplays an important role in the assessment of Bala. Avara Vyayama Shakti indicatesmore Dhatukshya and severity of the disease.Sleep: - sleep depends on severity of symptoms as well as mental state of a patient. Inthe present study all patient had disturbed sleep.SIGNS Quadriceps muscle wasting was observed in 21 patients it indicates the severity ofthe disease. Varus deformity was observed in 11 patients and suggests the involvement ofmedial compartment. Valgus deformity was observed in 3 patients, this shows the involvement of lateralcompartment.Basti Retention Time: Maximum time of Basti Retention noted i.e. 18 hours andminimum time noted i.e. 3 hour. Mean retention time was 9 hours. Initially, theretention time was less in some patients but gradually it was increased. Matra Basti
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   205  was given with 60 ml of Ashwagandha ghrita. As less quantity of ghrita is used inMatra Basti, it retains for maximum time in the body and does its work.DISCUSSION ON RESULTSThere was highly significant improvement in all 3 Sections.The questions pertaining to pain, stiffness and levels of difficulty in performingvarious functions are discussed.Pain: - In individual 5 questions pertaining to pain showed highly significantimprovement in 2 questions, statistically significant improvement in 2 questions andin 1 question no significance.Though there was highly significant improvement statistically but patients were notcompletely satisfied with amount of relief in symptoms. The same procedure whenrepeated after the study period in the same patient brought about better relief in painwhich showed that more sittings were required.Stiffness: -It  was  seen  that  the  result  of  treatment  in  morning  stiffness  showed  highly significant improvement, but stiffness occurring during the day showed no significant improvement.  Level of Difficulty in Performing Various FunctionsIt was seen that among all the activities most patients complained of difficulty ingetting up from squatting position. A clear proportionality relation was seen betweenreduction in pain and stiffness with that of level of difficulty in performing variousfunctions. This showed that pain and stiffness in patients influenced the ability ofpatients to work.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   206  Overall ResultIn overall assessment most patients had mild and moderate improvement.Matrabasti in JanusandhigatavataSnehana is the first line of treatment explained in the classics for Sandhigatavata.Here Snehana refers to both bahya and abhyantara Snehana. Abhyantara Snehana in the form of Matrabasti. Dalhanacharya opines that continuous Snehana is required in Sandhigatavata. Sushruta Samhita mentioned 9thsneha basti nourishes Asthi and Majja dhatu. Basti is indicated as the best therapeutic procedure for alleviating Vatadosha. Benefits of Matrabasti are Vatahara, Brumhana, and it acts like Rasayana(Dhatuposhana etc.).MODE OF ACTIONAccording to Ayurveda, treatment is ‘Vighatana of Samprapti‘, so the treatment ofJanusandhigatavata aims,1. Agnisamata –Ayurveda believes Mandagni is responsible for the production ofall the diseases. In Sandhigatavata Vriddhavastha leads Agnivaishamya and sameAgnivaishamya leads Vataprakopa. So to achieve Agnisamata is very essential forthe Shamana of the diseases.2. Vatashamana and Kaphavriddhi (Increase Snigdha guna) – InSandhigatavata, Rikta Srotas is in Asthi Sandhi. That means diminution ofSnehadi Guna in Asthi-Sandhi occurs which provides place to Vata to get situatedthere and so the disease Sandhigatavata produces. By treatment Rikta Srotas isfilled by Sneha. Thus Khavaigunya is corrected and so Shamana of
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   207  Sandhigatavata is achieved. Here Vatashamana and correction of Khavaigunya isachieved by treatment.3. Rasayana – Sandhigatavata specially occurs in Vriddhavastha due to Dhatukshya.A Rasayana drug nourishes Dhatus and overcomes Dhatukshya. So it should be infor the treatment of Sandhigatavata.4. Make surrounding tissue strong - Muscles, ligaments and tendons areresponsible for the joint stability. So surrounding tissue of the joint must be strongto prevent or cure the Osteoarthritis. If they are weak, joint damage will occursoon even with the minimal load. Treatment of osteoarthritis should be like that,which makes tissue strong. In Ayurveda, Sandhishula is one of the symptoms ofMamsakshya and Sandhisphutana is a symptom of Majjakshya.5. Provide materials which are required for healthy bone structure- Weak bonecan’t bear even normal load and it immediately gets damaged. So bone must behealthy and treatment should be like that only.For the present study, treatment was selected which is able to serve the entirerequirement as mentioned above to treat the disease Sandhigatavata.Ashwagandha Ghrita Matrabasti in JanusandhigatavataCharaka Samhita advocates Tikatadravya siddhaksheera or Ghrita basti inAsthivikara.In Bhaishajya Ratnavali Ashwagandha Ghrita is mentioned in vatavyadhi.Components of Ashwagandha Ghrita,1. Ashwagandha: -2. Ksheera: -
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   208  3. Ghrita: -Probable mode of action1. The drug Ashwagandha, a well known Rasayana drug, because of its Ushna,Snigdha, Laghu Guna, and Ushna Virya subsides Vata and Kapha and causesAgnideepana. As a result of this, the nutrients / essence reach the Dhatustraversing through the minutes Srotas. Thus, it helps in subsiding Vata dominantin old age causing Vayasthapana to some extent and Kapha dominant in earlyadulthood, enabling the essence reach all Dhatus.Ashwagandha is having Tikta-Katu-Kasaya Rasa, Madhura Vipaka, Ushna Virya, andUshna-Snigdha-Laghu-Sara Guna as said earlier.Action on Doshas: Being Ushna-Snigdha Guna, Madhura Rasa, Madhura Vipaka andUshna Virya, it subsides Vata.Action on Agni: Due to its Tikta-Katu Rasa which are dominant with Agni- Vayu-Akasha Mahabhuta and Ushna Virya, Ushna-Laghu-Snigdha Guna, it increasesJatharagni, which in turn influences all other Agni’s.Action on Srotas: As it is having Ushna-Laghu Guna, Ushna Virya, it removesSrotorodha, enters even the minutest channels of the body thereby showing thedesired effects.Action on Dhatus: Because of its Snigdha Guna, Madhura Rasa and Madhura Vipakawhich are dominant with Prithvi and Jala Mahabhuta, it helps in increasing theDhatus.Ashwagandha: - Decreases gastric ulcer, increases plasma corticosterone level(natural steroid). Normally with proceeding age the degenerative changes occur in
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   209  Joints, which are said to be irreversible, but with the help Ashwagandha Ghruta wecan stop or delayed the further deterioration of bone tissues or can maintain thequality of Bones and Joints. Ashwagandha Ghrita strengthens the muscles(Quadriceps).The pharmacological action of the different extracts from various part of the planthave been studied extensively, Withania somnifera has shown,1. Ashwagandha possesses anti-inflammatory, antitumor, antistress, antioxidant,immunomodulatory, hemopoetic, and rejuvenating properties. It also appears toexert a positive influence on the endocrine, cardiopulmonary, and central nervoussystems. (Alternative Medicine Review 2000; Vol. 5 (4) 334-346).2. Analgesic action, Twaj et al 1989.3. Studied on mice shown anti-stress activity and reduction in gastric ulcer, Grandhet al, 1994.Cow’s milk is the richest natural source of calcium present on the earth. The ratio inwhich calcium and phosphorus are present is ideal for their proper absorption andassimilation and consequently for bone formation along with vitamin D. Vitamin Dpresent in cows milk helps in bone formation by maintaining the proper levels ofcalcium in the blood along with the parathyroid hormone. Vitamin K activatesosteocalcin the major non collagen protein in the bone. Cow’s milk also containslactoferin an iron binding protein that boosts the growth and activity of theosteoblasts, the cells that build bone and reduces the rate at which these cells die byup to 50-70%. These also decrease the formation of osteoclasts, the cells responsible
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   210  for breaking down of the bone. Thus helping to build the bone and preventosteoporosis.Anulomana: - Haritaki churna does Deepana, Pachana, and Vatanulomana; by theseproperties it helps in purification of Srotas by which Veerya of sneha can spreadeasily through cleaned Srotas and finally better absorption of sneha takes place.Snehana: - Sneha reaches the Asthi Dhatu by performing Abhyanga for 800 Matrakala approximately 15 minutes. Sneha enyters the body through minute pores of skinby the virtue of its Anupravana bhava. Thus entering the Asthivaha srotas, it causesVishyandana. It destroys the obstruction in Asthivaha Srotas (Malanam VinihantiSangam ). Sneha is Vata Nashaka (Sneho anilam hanti). So it pacifies the Vata.Swedana: - Swedana also pacifies Vata especially, when performed after Snehana. IfSwedana is done after proper Snehana, it liquefies the Doshas which causesobstruction in the minute channels.Step wise mode of action of BastiBasti: - After proper Snehana and Swedana, Tikta Ksheera Basti is given to expelthese Doshas from the body to nourish the Kshina Asthi Dhatu. Sushruta says that theeighth basti enters the Asthi Dhatu. Thus entering the Asthi its action can beexplained on the following factors.Ashwagandha is Tikta, Katu, Kashya in Rasa and Madhura in Vipaka.Theaction of tikta ksheera basti on Asthi Dhatu can also be explained on the basis ofPancha Mahabhoutika composition. Predominance wise the Panchabhoutikacomposition of Asthi is Prithvi, Vayu, Agni, Akasha and Jala Mahabhuta. The Basticontains Ksheera, Ghrita, and Tikta dravya as its main ingredients. If we analyze thePanchabhoutika composition of Madhura, Tikta and Katu rasa it is Prithvi+ Jala,Vayu+ Akasha, and Agni+ Vayu respectively. Hene the total Panchabhoutika
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   211  composition of Basti dravya is similar to the Asthi dhatu and hence nourishes theAsthi.Due to the Vataghna property of Matrabasti there is shamana of aggravatedVata, by this the ksheena Asthi Dhatu returns to normalcy. The Basti reaches thePakwashaya which is the Purishadhara kala and the ingredients of basti ie Ksheera,Ghrita nourish the Purishadhara kala and thus also nourishes the Asthidhara kala.According to Modern embryology both bone tissue and the large intestine are formedby the mesenchymal cells of the mesoderm.Probable Pharmacokinetics and Pharmacodynamics of Ashwagandha GhritaBasti according to scientific parameters189.According to modern science basti as a process can be compared with the enema.There are 2 types of enemas. 1. Evacuation enema and 2. Retention enema. Ksheerabasti may be considered as the nourishing retention enema.Retention enema: - The fluid containing the drugs is retained in the rectum so thatthe drug may act locally e.g. steroid enema in ulcerative colitis. The rectum has richblood and lymph supply and drugs can cross the rectal mucosa like the other lipidmembranes; thus unionized and lipid soluble substances are readily absorbed from therectum, through the rectal venous plexus. The portion of the absorbed from the upperrectal mucosa is carried to the portal circulation where as that absorbed from thelower rectum enters directly into the systemic circulation.The absorption of the drug from the rectum follows the laws of transfer of themolecules across the biological membranes. Most drugs are absorbed by passivediffusion a few by active transport or carrier mediated transport. Pinocytosis is amechanism for transport of molecules across membranes. Usually unionized and lipidsoluble substances are absorbed by simple diffusion or passive diffusion. “Diffusion is
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   212  a law of transport of molecules from the region of higher concentration to the regionof lower concentration”. The absorption of the basti dravya is also by diffusion andmany factors influence this rate of diffusion and thus absorption. These factors are asfollows.Physical state: Liquids are absorbed better than solids.Ingredients of basti, their solubility and their homogenous mixing: Lipids and lipidsoluble drugs penetrate into the cell more rapidly than the water soluble drugs. Thehomogenous mixture of basti dravya is important.Temperature- Luke warm solutions are rapidly absorbed because of vasodilatation,whereas cold solutions are absorbed slowly.Size of the molecule, its disintegration time and dissolution time: Simpler andsmaller the size of the molecule, faster is the absorption. If the disintegration anddissolution time of the compound is less then the absorption is faster.Quantity and concentration gradient of the basti dravya: lesser the quantity morethe retention time. Concentrated solutions are absorbed more rapidly than the weaksolutions.pH of the GI fluid- Alkaline drugs are absorbed in the alkaline medium i.e. distalileum and large intestine, where as acidic drugs are absorbed in the stomach andproximal part of the small intestines.Ionization: Unionized component predominantly lipid soluble are absorbed rapidly.Surface area of absorption- Absorption is more in intestines than in stomach, becauseof the larger surface area of the former.Vascularity- Richer the vascularity greater the absorption.Structural and functional status of the rectum:
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   213  In the healthy and empty rectum the absorption is more and in the diseased condition,the presence of stool delays the absorption.The concentration of the basti dravyas is higher in the lumen of the rectum andin the cells surrounding the rectum. Hence the molecules of basti move from higherconcentration to the lower concentration i.e. from the rectum to the surrounding cellsand there, they are absorbed into the rectal veins. The lipid soluble substances likevitamin- A D and K and essential minerals such as calcium, phosphorus, magnesium,sodium, and chlorine etc present in the milk are in unionized form and hence absorbedrapidly. The surface area of the small intestine and rectum is more and it has very richblood supply, moreover the basti was given in the morning after the patient has passedthe stool i.e. when the rectum was empty. Hence all these factors enhance theabsorption of the basti dravyas from the rectum through the rectal mucosa. Recommendation for further study1. Literary studies on various concepts related to Jara such as Kalaja Jara, AkalajaJara, and Decade wise ageing process for better understanding of Jara conceptfrom Ayurvedic perspective.2. Literary studies on Role of Dincharya, Rutucharya, Sadvritta, and AcharaRasayana in preventing Akala Jara and delaying Kalaja Jara can be carried out,this will help not only in better understanding of Jara concept but also reveal roleof these factors in preventing Akala Jara and delaying Kalaja Jara.3. Experimental studies for laboratory analysis of various Rasayana Aushadhasquoted in classics for increasing Jara in order to find out their active ingredientswhich may help in better understanding of their mode of action.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   214  Clinical studies to evaluate effect Rasayana,4. Structural based Rasayana study in old age such as tissues/organs i.e. muscle,bone, brain, heart, etc.5. Functional based Rasayana study in old age such as immunity, fitness, sexuality,sense activity etc.6. Problem oriented Rasayana study in old age such as the weight loss, dehydration,anorexia, insomnia, etc.7. Disease oriented Rasayana study in old age such as Hypertension, Parkinsonism,Alzheimer’s, Dementia, Constipation etc.8. The present study can be done as Matrabasti with Shamana Aoushadhi with largesample size and longer duration.CONCLUSION Long and healthy life is one of the cherished desires of mankind. Ageing Process starts from the time of conception runs throughout the life spanultimately ceases with death. Akalaja jara is an outcome of not following Swasthavrutta (Dinacharya andRutucharya), Sadvrutta, Achararasayana, Stressful life style and incorrect dietaryhabits which can be treated with rasayana therapy. Ageing process can be slowed down by rejuvination therapy.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   215   Rasayana is having preventive, promotive and curative properties which aresimilar to adapogens, antioxidants, immunostimulants, nootropics, anabolics andother geriatric remedies. Rasayana acts at the level of Agni, Rasa and Srotus. Kala, Swabhava, and Vayu play a major role in Ageing Process, while AharaSousthava (Dietary Habits), Lifestyle and Avighata (disturbed Manasika Bhava-Stress) are the contributing factors. Ashwagandha Ghrita Matrabasti was found very effective in Pain and othersymptoms. Statistics showed highly significant improvement in 3 Sections of WOMAC Scalei.e. pain, stiffness and level of difficulty in performing physical activities. In overall assessment most patients had mild and moderate improvement. The aim of Jara-Chikitsa is “Longer life with lesser disease and painless death”,which is in tune with the Indian philosophy of:“AlÉÉrÉÉxÉålÉ qÉUhÉÇ ÌuÉlÉÉ SælrÉålÉ eÉÏÌuÉiÉqÉç”It means a peaceful death and self sufficient life. SUMMARYThe  Thesis  entitled  “A  study  on  Jara  w.s.r.  to  role  of  Matrabasti  in Janusandhigatvata”  was        aimed  to  systematically  compile  and  analyse  the  Jara concept  and  to  observe  the  effect  of  Ashwagandha  Ghrita  Matrabasti  in Janusandhigatavata.  Parameter  i.e.  WOMAC  scale  was  taken  as  a  parameter  to assess and analyze the results.  
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   216  The study consists of 2 parts viz. Conceptual Study, Clinical Study,Jara is the stage of life when the body tissues begin to attain flaccidity. Jara is one ofthe Swabhavika Vyadhi of life after 60/70 years. It is Vata dominant state occurringinspite of prevention and which is upachararahita (untreatable), Yapya (palliable),kalakrita vyadhi (timely occurring) and requiring supernatural rejuvenation (atyantikarasayana) to reverse the agony.Sushruta Samhita classifies the Jara into two types, Kalaja and Akalaja Jara. Jaracoming at the proper age is Kalaja Jara i.e., after 70 years of life. It is inevitable andthere are no causative factors that exist to prevent its occurrence, hence Dalhanacalled it as “Parirakshankrita” that means it occurs even by following preventivehealth care measures. Akala Jara that is acquired one. Hence Dalhana called it is“Aparirakshankrita” that means it occurs by following improper health caremeasures.Jara is the stage of the life where, Vata is in the dominant state and Rasadisaptadhatu are in deprived state. This potent combination are responsible for the agedpeople and they are made prone to Vatavikaras; among the VatavikarasSandhigatvata is commonest one, especially Janusandhigatvata.Rasayana drugs are a group of medicinal preparations having Balya, Medhya,Agnivardhaka, Ojovardhaka, and Vayasthapana etc. and had been also proven thepharmacological properties like Immunomodulator, Adaptogenic, Antistress,Antianxiety, Antidepressant, and Hepatoprotective etc. Different Rasayana drugformulations are having different pharmaco dynamics to counteract the AgeingProcess.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   217  In the clinical study, 30 patients had completed the course of therapy. AshwagandhaGhrita Matrabasti was administered for 9 days and follow up period was 18 days. Thedifferent parameters of the study were recorded before treatment, after treatment andafter the follow-up. The Observations and Results were statistically analyzed forbetter interpretation.Improvement in WOMAC scale was highly significant (P< 0.001) result. Theconclusion derived on the basis of detailed observation & deep study is submittedunder the chapter on Conclusion. Future perspective of the study is highlighted as anaid for the future research scholars.BIBLIOGRAPHY AND REFERENCES
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   218  1. Journal of Research in Ayurveda and Siddha, CCRAS, New Delhi, Oct-Dec2007, Vol. XXVIII, No.4,PP: 22. Taranath Tarkavachaspathy Bhattacharya, Vacaspatyam, part four, Varanasi,Chowkambha Sanskrit Series, 1969, PP: 3058.3. Taranatha Bhattacharya, Shabdastoma Mahanidhi, 3rdEdition, Varanasi,Chowkambha Sanskrit Series, 1967, PP: 181.4. Taranath Tarkavachaspathy Bhattacharya, Vacaspatyam, part four, Varanasi,Chowkambha Sanskrit Series, 1969, PP: 3058.5. Vasudev Laxman Shastri Pansikar, Dwitiya khanda, Amarakosha, 7thEdition,Bombay, Nirnaya Sagar Press, 1934, PP: 118.6. Dr.Suresh Babu, Geriatrics in Ayurveda, Chowkhambha Orientalia, Varanasi,1stEdition, 2001, PP: 11.7. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP: 298.8. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 155.9. Hemaraja Sharma, Kashyapa Samhita of Vruddha Jivaka, Varanasi,Choukambha Sanskrit Sansthan, 2006, PP: 246.10. Acharya Y.T, Acharya Nandakishora Sharma, Sushruta Samhita of Sushrutawith Bhanumati Commentary, Mumbai, Nirnaya Sagar Press, 1939,PP.24.11. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 115.12. Vaidhya Hari Sadashiva shastri Paradakara, Ashtanga Hrudaya of Vagbhata,9thEdition, Varanasi, Choukhamba Sanskrit Prakashana, Reprinted 2009, PP:6.13. Brahma Shankar Mishra, Bhavprakasha of Bhavamishra Vol. 1, 11thEdition,Varanasi, Choukhamba Sanskrit Sansthan, 2009, PP: 102.14. Dr.Suresh Babu, Geriatrics in Ayurveda, Chowkhambha Orientalia, Varanasi,1stEdition, 2001, PP: 11.15. Williams M.M, Sanskrit-English Dictionary, Varanasi, Motilal Banarsidass,Reprinted 1990, PP: 414.16. Williams M.M, Sanskrit-English Dictionary, Varanasi, Motilal Banarsidass,Reprinted 1990, PP: 414.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   219  17. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP: 280.18. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP: 280.19. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 155.20. Hemaraja Sharma, Kashyapa Samhita of Vruddha Jivaka, Varanasi,Choukambha Sanskrit Sansthan, 2006, PP: 246.21. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 2ndedition, Varanasi,Choukhamba Sanskrit Series Office, 2008, PP: 330.22. Vaidhya Hari Sadashiva shastri Paradakara, Ashtanga Hrudaya of Vagbhata,9thEdition, Varanasi, Choukhamba Sanskrit Prakashana, Reprinted 2009, PP:405.23. Brahma Shankar Mishra, Bhavprakasha of Bhavamishra Vol. 1, 11thEdition,Varanasi, Choukhamba Sanskrit Sansthan, 2009, PP: 101.24. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP: 280.25. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 115.26. Kavirajashree Narendranath Sen Gupta, Kavirajashree Balaichandra SenGupta, Charaka Samhita of Agnivesha, 2nd Edition, Vol 3 ChoukhambaPrakashana, Varanasi, 2002, PP: 1841.27. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 63.28. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP: 97.29. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP: 616.30. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 257.31. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP: 339.32. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP: 332.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   220  33. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP: 336.34. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:278.35. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP: 280.36. Brahma Shankar Mishra, Bhavprakasha of Bhavamishra Vol. 1, 11thEdition,Varanasi, Choukhamba Sanskrit Sansthan, 2009, PP: 101.37. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 64.38. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:512.39. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 71.40. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:381.41. Indradeva Tripathi, Rasaratnasamucchaya, Varanasi, Choukhamba SanskritPrakashan, Reprinted 2009, PP: 347.42. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:245.43. Yogindra Nath Sen, Charaka Samhita of Charaka, 3rdVol. Banaras,Choukhamba Sanskrit Series Office, 1922, PP: 1455.44. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:280.45. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:381.46. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 155.47. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 2ndEdition, Varanasi,Choukhamba Sanskrit Series Office, 2008, PP: 330.48. Brahma Shankar Mishra, Bhavprakasha of Bhavamishra Vol. 1, 11thEdition,Varanasi, Choukhamba Sanskrit Sansthan, 2009, PP: 102.49. Kshemaraj Shri Krishnadas, Harita Samhita of Harita, Mumbai,Venkateshwara Mudranalaya, 1984, PP: 28.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   221  50. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:79.51. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 2ndEdition, Varanasi,Choukhamba Sanskrit Series Office, 2008, PP: 149.52. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:80.53. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 2ndEdition, Varanasi,Choukhamba Sanskrit Series Office, 2008, PP: 149.54. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:80.55. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 2ndEdition, Varanasi,Choukhamba Sanskrit Series Office, 2008, PP: 149.56. Giriraja Dhayalu Shukla, Bhela Samhita of Bhela, 1stEdition, Varanasi,Choukhamba Bharati Academy, Reprint,1999, PP: 82.57. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:79.58. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 261.59. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 2ndEdition, Varanasi,Choukhamba Sanskrit Series Office, 2008, PP: 331.60. Parashuram Shastri Vidyasagar, Sharangadhara Samhita of Sharangadhara,Varanasi, Choukhamba Surabharati Prakashan, 1stEdition, 2006, PP: 72.61. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:541.62. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:641.63. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 71264. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:113.65. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:181.66. Brahma Shankar Mishra, Bhavprakasha of Bhavamishra Vol. 1, 11thEdition,Varanasi, Choukhamba Sanskrit Sansthan, 2009, PP: 150.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   222  67. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 502.68. Giriraja Dhayalu Shukla, Bhela Samhita of Bhela, 1stEdition, Varanasi,Choukhamba Bharati Academy, Reprint,1999, PP: 10.69. Giriraja Dhayalu Shukla, Bhela Samhita of Bhela, 1stEdition, Varanasi,Choukhamba Bharati Academy, Reprint,1999, PP: 7.70. Vaidhya Hari Sadashiva shastri Paradakara, Ashtanga Hrudaya of Vagbhata,9thEdition, Varanasi, Choukhamba Sanskrit Prakashana, Reprinted 2009, PP:34.71. Vaidhya Hari Sadashiva shastri Paradakara, Ashtanga Hrudaya of Vagbhata,9thEdition, Varanasi, Choukhamba Sanskrit Prakashana, Reprinted 2009, PP:140.72. Vaidhya Hari Sadashiva shastri Paradakara, Ashtanga Hrudaya of Vagbhata,9thEdition, Varanasi, Choukhamba Sanskrit Prakashana, Reprinted 2009, PP:24.73. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:388.74. Acharya Y.T, Acharya Nandakishor Sharma, Sushruta Samhita of Sushrutawith Bhanumati Commentary, Mumbai, Nirnaya Sagar Press, 1939,PP.12.75. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:376.76. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 3.77. Parashuram Shastri Vidyasagar, Sarngadhara Samhita of Sarngadhara,Varanasi, Chaukhamba Surbharati Prakashan, 2006, PP: 37.78. Shree Lakshmipati Shastri, Yogaratnakara, Varanasi, ChoukhambaSurabharati Prakashana, Reprinted 2010, PP: 498.79. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 498.80. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:376.81. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP: 380.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   223  82. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 498.83. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 499.84. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 498.85. Vaidhya Hari Sadashiva shastri Paradakara, Ashtanga Hrudaya of Vagbhata,9thEdition, Varanasi, Choukhamba Sanskrit Prakashana, Reprinted 2009, PP:940.86. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:298.87. Indradeva Tripathi, Rasaratnasamucchaya, Varanasi, Choukhamba SanskritPrakashan, Reprinted 2009, Page number: 8.88. Indradeva Tripathi, Rasaratnasamucchaya, Varanasi, Choukhamba SanskritPrakashan, Reprinted 2009, PP: 4-5.89. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 115.90. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:256.91. Hemaraja Sharma, Kashyapa Samhita of Vruddha Jivaka, Varanasi,Choukambha Sanskrit Sansthan, 2006, PP: 246.92. Hemaraja Sharma, Kashyapa Samhita of Vruddha Jivaka, Varanasi,Choukambha Sanskrit Sansthan, 2006, PP: 244-245.93. Vaidhya Hari Sadashiva shastri Paradakara, Ashtanga Hrudaya of Vagbhata,9thEdition, Varanasi, Choukhamba Sanskrit Prakashana, Reprinted 2009, PP:158.94. Journal of Research in Ayurveda and Siddha, CCRAS, New Delhi, 2008,Dept. of AYUSH, Abhinav Printers, Delhi-34.95. Paola S. Timiras, Physiological basis of Ageing and Geriatrics, 4thEdition,Informa health care, New York,2007 ,PP:796. http://thesaurus.com/browse/old+age.97. Paola S. Timiras, Physiological basis of Ageing and Geriatrics, 4thEdition,Informa health care, New York,2007 ,PP:7
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   224  98. Paola S. Timiras, Physiological basis of Ageing and Geriatrics, 4thEdition,Informa health care, New York, 2007, PP: 57.99. http://www.wrongdiagnosis.com/sym/premature_ageing.htm100. K.C.Mathur, Short textbook of Physiology, 1stEdition, 2006, page number 63.101. Paola S. Timiras, Physiological basis of Ageing and Geriatrics, 4thEdition,Informa health care, New York, 2007, PP: 45.102. Cecil Medicine, 23rd Edition, Saunders Elsevier,Philadelpia,2007,PP:107103. Cecil Medicine, 23rd Edition, Saunders Elsevier,Philadelpia,2007,PP:107104. Cecil Medicine, 23rd Edition, Saunders Elsevier,Philadelpia,2007,PP:107105. Paola S. Timiras, Physiological basis of Ageing and Geriatrics, 4thEdition,Informa health care, New York, 2007, PP: 290.106. Cecil Medicine, 23th Edition, Saunders Elsevier,Philadelpia,2007,PP:108107. Paola S. Timiras, Physiological basis of Ageing and Geriatrics, 4thEdition,Informa health care, New York, 2007, PP: 385.108. Cecil Medicine, 23rd Edition, Saunders Elsevier,Philadelpia,2007,PP:108109. Paola S. Timiras, Physiological basis of Ageing and Geriatrics, 4thEdition,Informa health care, New York, 2007, PP: 200.110. Cecil Medicine, 23rd Edition, Saunders Elsevier,Philadelpia,2007,PP:108111. Cecil Medicine, 23rd Edition, Saunders Elsevier,Philadelpia,2007,PP:109112. K.C.Mathur, Short textbook of Physiology, 1stEdition, 2006, page number 62.113. Cecil Medicine, 23rd Edition, Saunders Elsevier,Philadelpia,2007,PP:109114. Paola S. Timiras, Physiological basis of Ageing and Geriatrics, 4thEdition,Informa health care, New York, 2007, PP: 109.115. Paola S. Timiras, Physiological basis of Ageing and Geriatrics, 4thEdition,Informa health care, New York, 2007, PP: 325.116. Paola S. Timiras, Physiological basis of Ageing and Geriatrics, 4thEdition,Informa health care, New York, 2007, PP: 356.117. Paola S. Timiras, Physiological basis of Ageing and Geriatrics, 4thEdition,Informa health care, New York, 2007, PP: 359.118. http://en.wikipedia.org/wiki/Life extension#cite_note-EMBOSENS-3119. Davidson’s Principles and Practice of Medicine, 20thEdition, ChurchillLivingstone, 2002, PP: 163.120. Paola S. Timiras, Physiological basis of Ageing and Geriatrics, 4thEdition,Informa health care, New York, 2007, PP: 28.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   225  121. Dr. G.P.Talwar, Textbook of biochemistry and Human biology, 2ndEdition,Prentice Hall of India, New Delhi,1989, PP:1141.122. Dr. G.P.Talwar, Textbook of biochemistry and Human biology, 2ndEdition,Prentice Hall of India, New Delhi,1989, PP: 1142.123. Taranath Tarkavachaspathy Bhattacharya, Vacaspatyam, part four, Varanasi,Chowkambha Sanskrit Series, 1969, PP: 3113.124. Williams M.M, Sanskrit-English Dictionary, Varanasi, Motilal Banarsidass,Reprinted 1990, PP: 418.125. Taranath Tarkavachaspathy Bhattacharya, Vacaspatyam, part six, Varanasi,Chowkambha Sanskrit Series, 1969, PP: 5212 .126. Williams M.M, Sanskrit-English Dictionary, Varanasi, Motilal Banarsidass,Reprinted 1990, PP: 1144.127. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 367.128. Taranath Tarkavachaspathy Bhattacharya, Vacaspatyam, part four, Varanasi,Chowkambha Sanskrit Series, 1969, PP: 2513.129. Williams M.M, Sanskrit-English Dictionary, Varanasi, Motilal Banarsidass,Reprinted 1990, PP: 347.130. Taranath Tarkavachaspathy Bhattacharya, Vacaspatyam, part six, Varanasi,Chowkambha Sanskrit Series, 1969, PP: 4873.131. Williams M.M, Sanskrit-English Dictionary, Varanasi, Motilal Banarsidas,Reprinted 1990, PP: 934.132. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,Chaukhambha Prakashan, 2007, PP: 620.133. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 368.134. Parashuram Shastri Vidyasagar, Sharangadhara Samhita of Sharangadhara,Varanasi, Choukhamba Surabharati Prakashan, 2006, PP: 52.135. Parashuram Shastri Vidyasagar, Sharangadhara Samhita of Sharangadhara,Varanasi, Choukhamba Surabharati Prakashan, 2006, PP: 56.136. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 356.137. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 376.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   226  138. Parashuram Shastri Vidyasagar, Sharangadhara Samhita of Sharangadhara,Varanasi, Choukhamba Surabharati Prakashan, 2006, PP: 52.139. Vaidhya Hari Sadashiva shastri Paradakara, Ashtanga Hrudaya of Vagbhata,9thEdition, Varanasi, Choukhamba Sanskrit Prakashana, Reprinted 2009, PP:193.140. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 259.141. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:617.142. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:617.143. Vaidhya Hari Sadashiva shastri Paradakara, Ashtanga Hrudaya of Vagbhata,9thEdition, Varanasi, Choukhamba Sanskrit Prakashana, Reprinted 2009, PP:530-531.144. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:618.145. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 261.146. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 2ndEdition, Varanasi,Choukhamba Sanskrit Series Office, 2008, PP: 414.147. Vaidhya Hari Sadashiva shastri Paradakara, Ashtanga Hrudaya of Vagbhata,9thEdition, Varanasi, Choukhamba Sanskrit Prakashana, Reprinted 2009, PP:531.148. Yadunandana Upadhyaya, Madava Nidana Vol 1, Varanasi, ChaukhambhaSanskrit Sansthan, Reprint 2003, PP: 463.149. Brahma Shankar Mishra, Bhavprakasha of Bhavamishra Vol. 1, 11thEdition,Varanasi, Choukhamba Sanskrit Sansthan, 2009, PP: 264.150. Shree Lakshmipati Shastri, Yogaratnakara, 1stEdition, Varanasi, ChoukhambaPrakashan, Reprint 2010, PP: 505.151. Yadunandana Upadhyaya, Madava Nidana Vol 1, Varanasi, ChaukhambhaSanskrit Sansthan, 2003, PP: 575, 560-561, 541, 520.152. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:621.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   227  153. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 420.154. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 2ndEdition, Varanasi,Choukhamba Sanskrit Series Office, 2008, PP: 565.155. Vaidhya Hari Sadashiva shastri Paradakara, Ashtanga Hrudaya of Vagbhata,9thEdition, Varanasi, Choukhamba Sanskrit Prakashana, Reprinted 2009, PP:724.156. Indradeva Tripathi, Chakradatta of Chakrapanidatta, Varanasi, ChoukhambaSanskrit Bhavana, Reprint, 2010, PP: 133.157. Shree Lakshmipati Shastri, Yogaratnakara, 1stEdition, Varanasi, ChoukhambaPrakashan, Reprint 2010, PP: 517.158. Brahma Shankar Mishra, Bhavprakasha of Bhavamishra Vol. 1, 11thEdition,Varanasi, Choukhamba Sanskrit Sansthan, 2009, PP: 265.159. Ambikadatta Shastri, Bhaisajya Ratnavali of Kaviraj Govind Das Sen, 20thEdition, Varanasi, Chaukhamba Prakashan, 2010, PP: 529.160. Indradev Tripathi & Dayashankar Tripati, Yogaratnakara, 1stEdition,Varanasi, KrishnadasAcademy, 1998, PP: 434, 437, 418, 420-423.161. Siddhi Nandan Mishra, Bhaisajya Ratnavali of Kaviraj Govind Das Sen,Reprinted, Varanasi, Chaukhamba Surbharati Prakashan, 2007, PP: 546, 610,604-605,608.162. Ravidatta Shastry, Chakradatta of Chakrapanidataa, 4thEdition, Varanasi,Chaukhamba Surbharati Prakashan, 2006, PP: 139, 148, 150,153.163. http://www.yourdictionary.com/osteoarthritis164. en.wiktionary.org/wiki/osteoarthritis165. en.wikipedia.org/wiki/Osteoarthritis166. B. D Chaurasia, Human Anatomy, 7th Reprinted, New Delhi, CBS Publishersand Distributors, 2002, PP: 124-130167. Harrison’s Principles of Internal Medicine, Vol 2, 13th Edition, 1994,McGrew Hill Book Company, Singapore, PP:1693168. L.C.Gupta etl, Differential Diagnosis, 7thEdition, New Delhi, Jaypee BrothersMedical Publishers (P) Ltd, 2005, PP: 121-123.169. Harrison’s Principles of Internal Medicine, Vol 2, 13th Edition, 1994,McGrew Hill Book Company, Singapore, PP:1696
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   228  170. Harrison’s Principles of Internal Medicine, Vol 2, 13th Edition, 1994,McGrew Hill Book Company, Singapore, PP:1697171. Raja Radha Kantha Deva, Shabda Kalpa Druma, part 3, 3rdEdition, Varanasi,Choukhamba Sanskrit Series ,1967,PP:696.172. H.S.Kasture, Ayurvediya Panchakarma Vignana, 7thEdition, Patna, ShriBhaidyanath Ayurveda Bhavan Ltd, 2005, PP: 371.173. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:701.174. Vaidhya Hari Sadashiva shastri Paradakara, Ashtanga Hrudaya of Vagbhata,9thEdition, Varanasi, Choukhamba Sanskrit Prakashana, Reprinted 2009, PP:283.175. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:701.176. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 2ndEdition, Varanasi,Choukhamba Sanskrit Series Office, 2008, PP: 213.177. Vaidhya Hari Sadashiva shastri Paradakara, Ashtanga Hrudaya of Vagbhata,9thEdition, Varanasi, Choukhamba Sanskrit Prakashana, Reprinted 2009, PP:283.178. Hemaraja Sharma, Kashyapa Samhita of Vruddha Jivaka, Varanasi,Choukambha Sanskrit Sansthan, 2006, PP: 285.179. Parashuram Shastri Vidyasagar, Sharngadhara Samhita of Sharngadhara,Varanasi, Chaukhamba Surbharati Prakashan, 2006, PP: 320.180. Shivdas Sen, Chikitsasamgrahagrantha of Chakrapanidatta, Varanasi,Choukhamba Orientals, 1992, PP: 867.181. Kaviraja Atrideva Gupta, Ashtanga Hrudaya, Reprint 2007, ChoukhambaPrakashana, Varanasi, PP:130182. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:114.183. Acharya Y.T, Charaka Samhita of Agnivesha, Rashtriya Sanskrit Sansthan,New Delhi, Choukhamba Prakashana, Varanasi, 2006, PP:682.184. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 527.185. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 2ndEdition, Varanasi,Choukhamba Sanskrit Series Office, 2008, PP: 605.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   229  186. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi,Choukhamba Surabharati Prakashana, Reprinted 2010, PP: 574.187. P.V.Sharma, Dravya Guna Vignana, part two, 16thEdition, Varanasi,Chowkhamba Vishwabharati, 1994, PP: 753 and 763.188. Dr.K.C.Chunekar, Dr.G.S.Pandey, Bhavaprakasha Nighantu, ChowkhambaVishwabharati, Reprint, 1998, PP: 759 and 775.189. Sanjay Kadlimatti,P.G Subbanna gouda- Clinical Evaluation of the role oftikta ksheera basti and ajasthi bhasma in the management of Asthi kshaya vis-a-vis Osteoporosis- Ayu Journal Vol-30 N0-2 (April-June) 2009 PP-131-141.
  • DRUGS USED IN STUDY   
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata Dr.Kalyani Ashok Bhusane             XII   SL.NO SEX AGE RLG OCN EDU DIET CHR S.E.S. HBT PKR SRA SMH STV BALA1  2 68 1 1 3 1 16 2 2 1 3 2 3 32  2  62  1  1  3  1  1  2  2  2  2  2  2  2 3  1  62  1  2  2  2  3  1  1  2  2  2  2  2 4  1  70  1  2  1  1  12  1  1  1  3  3  2  2 5  2  70  1  1  1  1  6  2  1  3  2  2  2  2 6  1  62  1  3  4  1  1  2  2  2  2  2  2  2 7  1  71  1  3  4  1  7  3  2  2  3  3  2  3 8  1  68  1  2  3  1  4  2  2  3  2  2  2  2 9  1  65  1  3  4  1  6  2  1  2  3  2  2  2 10  2  71  1  1  2  2  6  1  2  2  2  2  2  2 11  1  65  1  2  1  2  5  1  1  2  2  2  2  2 12  1  75  1  2  1  2  12  1  1  2  3  3  3  2 13  2  66  1  1  1  1  6  1  1  2  2  2  2  2 14  1  67  1  3  4  1  7  2  2  2  2  2  2  2 15  1  65  1  2  3  1  8  1  1  2  2  2  2  2 16  1  74  1  3  4  1  10  2  2  2  2  2  2  2 17  2  75  1  1  3  1  14  2  2  2  3  2  3  3 18  1  61  1  3  4  1  3  2  2  2  2  2  2  2 19  1  60  1  2  1  2  4  1  1  2  3  2  2  2 20  1  70  2  3  3  2  3  2  2  2  2  2  2  2 21  1  71  1  2  1  1  6  1  1  2  2  2  2  3 22  2  65  1  1  1  1  3  1  1  4  2  2  2  3 23  2  63  1  1  1  1  3  1  1  2  2  3  2  2 24  2  65  1  1  1  1  4  1  1  2  2  2  3  3 25  2  60  1  1  1  1  5  1  1  2  2  3  2  3 26  2  65  1  1  1  1  4  1  1  3  3  3  3  2 27  2  65  1  1  1  1  2  1  1  2  2  3  2  3 28  1  70  1  2  2  2  5  1  1  2  2  2  2  2 29  1  62  1  2  2  2  2  1  1  2  2  3  2  3 30  1  72  1  2  1  2  6  1  1  2  2  2  3  2 
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata Dr.Kalyani Ashok Bhusane             XIII  P1 P2 P3 P4 P5 S1 S2 PA1 PA2 PA3SL NOBT AT AFU BT AT AFU BT AT AFU BT AT AFU BT AT AFU BT AT AFU BT AT AFU BT AT AFU BT  AT  AFU  BT AT AFU1 2 2 1 3 2 2 2 1 1 2 1 1 2 1 1 2 1 2 1 1 1 3 2 2 3 2 2 2 1 22  2  2  1  3  3  2  2  2  1  2 1  1  2  2  2  2  2  2  2  1  1  3  2  2  3  2  3  2  2  2 3  3  2  2  3  3  2  2  2  1  2  1  1  2  1  2  2  1  2  1  1  1  3  2  3  3  2  3  3  1  2 4  2  2  2  3  3  2  3  2  2  2  1  1  2  2  1  2  1  2  2  1  1  3  3  3  3  3  3  2  2  2 5  2  1  2  3  2  2  2  1  1  1  1  1  2  1  2  2  1  2  1  0  1  3  2  3  3  3  3  2  2  2 6  2  1  1  2  2  1  2  1  1  1  0  0  1  1  0  2  1  1  0  0  0  2  2  1  2  2  2  1  1  1 7  2  1  1  3  2  2  2  1  1  1  1  1  1  1  1  2  1  1  1  1  0  3  2  2  3  2  3  2  1  2 8  2  1  1  3  2  2  2  2  1  2  0  1  2  1  1  2  1  1  2  1  1  3  2  2  3  2  2  2  1  1 9  2  1  1  3  2  2  2  1  1  1  1  0  1  1  1  2  1  1  1  0  0  2  2  2  3  2  3  2  1  2 10  2  1  1  3  2  2  2  1  1  1  0  0  1  1  1  2  1  1  1  0  0  2  2  2  2  3  2  2  1  1 11  1  1  1  2  1  2  1  1  2  1  0  1  1  0  1  1  1  1  1  1  0  2  2  2  2  2  2  1  1  1 12  2  2  1  3  2  2  2  1  1  1  1  1  1  1  1  2  1  2  1  1  1  3  2  3  3  3  3  2  2  2 13  2  1  1  3  2  2  1  1  2  1  1  1  1  1  1  1  2  1  0  1  0  3  2  1  2  2  2  2  1  1 14  2  1  1  3  2  2  2  1  1  1  1  1  1  1  1  2  1  2  1  1  1  3  2  2  2  2  2  2  2  1 15  1  1  1  3  2  3  1  1  1  1  1  1  1  1  1  2  2  2  1  1  1  3  3  3  3  3  3  2  2  2 16  2  2  2  4  3  3  2  2  1  1  1  1  1  2  2  2  2  2  1  1  1  3  3  2  3  3  3  2  2  2 17  2  2  2  4  3  3  2  2  1  1  1  1  2  2  2  2  2  2  1  1  1  3  3  2  4  3  3  2  2  2 18  1  1  1  2  2  2  1  1  1  0  0  0  1  1  0  1  1  1  0  0  0  2  1  1  2  1  1  1  1  1 19  1  1  1  2  1  1  1  1  1  0  0  0  1  0  1  1  1  1  0  0  0  2  1  2  2  2  2  1  1  1 20  2  1  2  3  2  2  1  1  1  1  1  0  1  1  1  2  2  1  1  0  0  3  2  2  3  2  3  2  2  2 21  2  1  1  3  2  3  2  1  2  1  1  1  1  1  1  2  2  2  1  1  1  2  2  2  3  3  3  2  2  2 22  1  1  1  2  2  2  1  1  1  1  1  1  1  1  1  1  2  2  0  0  0  2  2  2  2  2  3  2  1  1 23  2  1  1  3  2  2  2  1  1  1  1  1  1  2  1  2  1  1  1  1  1  3  2  2  3  3  2  2  1  1 24  1  1  1  2  2  2  1  1  1  1  1  1  1  2  1  2  1  1  1  1  1  2  2  2  3  2  3  2  1  2 25  2  1  1  2  2  2  1  1  1  1  1  1  1  2  1  2  1  1  1  0  0  3  2  1  2  3  2  2  1  1 26  2  2  1  3  2  2  2  1  1  1  1  1  2  1  1  2  1  2  1  1  1  3  2  2  3  3  3  2  2  2 27  1  1  1  2  2  2  1  1  1  1  0  0  1  1  0  1  1  1  0  0  o  2  2  2  3  2  2  1  1  1 28  1  1  1  3  2  3  1  1  1  1  1  1  1  1  1  2  1  2  1  1  1  2  2  2  3  2  3  2  1  2 29  2  1  1  3  2  2  1  1  1  1  1  1  1  1  1  2  1  1  1  1  1  3  2  2  3  3  2  2  1  1 30  2  1  1  3  2  2  1  1  1  1  1  1  2  1  1  2  2  1  1  1  1  3  3  3  3  3  3  2  2  2  
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   I   CASE SHEETDEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTAGOVERNMENT AYURVEDA MEDICAL COLLEGE,MYSORE.A STUDY ON JARA W.S.R. TO ROLE OF MATRABASTI INJANUSANDHIGATAVATAHEAD OF THE DEPARTMENT : Dr. Anjaneya Murthy M.D. (Ayu)GUIDE : Dr.Anjaneya Murthy M.D. (Ayu)CO-GUIDE : Dr. Anand Katti. M.D. (Ayu)RESEARCHER : Dr. Kalyani Ashok BhusanePart A: History taking and Clinical ExaminationPart B: InterpretationPart C: Observation and AssessmentPart A: History taking and Clinical ExaminationName of the Patient: Case No. :Age: O.P. No. :Sex: Male / Female I. P. No. :Religion: H/M/C/Others Ward No. :Marital Status:M/UM/W/D Bed No. :Socio-economic status: VP/P/LM/M/UM/R Date of admission:Education: Ill/PS/MS/HS/G/PG Date of discharge:Address: Result:Phone No:
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   II   I. VEDANA VRITTANTA:A. PRADHANA VEDANA: DURATION JANU SANDHI SHULA: JANU SANDHI SHOTHA: ATOPA: STHABDHATA: PRASARAN AAKUNCHANAYO VEDANA: SPARSHA ASAHYATA:        B. ANUBANDHI VEDANA: DURATION  II. ADYATANA VYADHI VRITTANTA:A. JANU SANDHI SHULA:i. Presentation- Unilateral L / R1. Bilateralii. Mode of onset- Sudden / Gradualiii. Severity of Pain-Deep ache / dull acheiv. Duration of Pain- Lasts for minutes, hours, daysv. Aggravating factors- Exercise, food habits, time factor.vi. Relieving factors-Rest, food habits, time factor, analgesics.vii. Pain interfere with sleep-  
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   III   B. JANU SANDHI SHOTHA:I. Mode of onset- Following trauma, dislocation, spontaneousdevelopment.ii. Time of onset- Precedes pain, Recedes pain.iii. Inflammatory changes- Present, absent.C. ATOPA:i. Audible/ Palpable.ii. Symmetrical / AsymmetricalD. STHABDHATA:i. Range of different movements of knee jointii. Restricted / not restrictediii. Stiffness-iv. Nature - Morning stiffness.v. Duration-vi. Symmetrical / AsymmetricalE. PRASARAN AAKUNCHANAYO VEDANA:F. SPARSHA ASAHYATA:III. POORVA VYADHI VRITTANTA:i. Diseases:ii. Hospitalization:iii. Operation:
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   IV   IV. CHIKITSA VRITTANTA:i. Case- Fresh / treated / under treatmentii. Previous medication – Allopathic / Homeopathy/ Ayurvedic / otheriii. Drugs used-iv. Response- No / mild / moderate / goodv. Present status-V. PAARIVARIKA VRITTANTA:I. MATRIJA: Present / AbsentII. PITRAJA: Present / AbsentVI. VAYAKTIKA VRITTANTA:i. Nature of work: Hard manual work / Moderate manual work / Mild work /Sedentary workii. Hours of work:iii. Symptoms produced during working hours:iv. Whether relived during holidays:v. Exercise: Hours of rest in a day.vi. Dietic habit- Samashana / Vishamashana / Anshan / Adhyashana .vii. Diet: Veg/ Non-vegviii. Nature of food:1. Heavy as usual meals : Yes / No2. Small quantity with increased frequency: Yes / No3. Use of snacks between meals: Yes / No4. Predominant tastes: Sw / So / Sa / Pu / Bi / As / All5. Predominant guna : Sn / Ru / Us / Sh / Anyix. Appetite: Poor / Moderate / Good / Severex. Sleep: Sound / Disturbed / Excess
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   V   xi. Habits: Smoking/ Beetle leaf / Tobacco chewing / Alcohol / Drugs / Tea /Coffee Others.xii. Micturation:xiii. Bowels:1. GYNELOGICAL & OBSTETRIC HISTORY:i. Gynelogical history:Menarche: Menopause:ii. Obstetric history: G P D A LVII. SAMANYA PAREEKSHA:1] Pulse: 6] Conjunctiva:2] B.P: 7] Tongue:3] R.R. 8] Nails:4] Height: 9] Lymph nodes:5] Weight: 10] Oedema:VIII. EXAMINATION OF JOINT:Darshana:Gathi: Swinging gait ( ), Limping gait ( ).Swelling: Present ( ), Absent ( ).Muscular wasting: Present ( ), Absent ( ).Sparshana:Local temperature: Present ( ), Absent ( ).Local tenderness: Present ( ), Absent ( ).Swelling:Fluctuation: Positive ( ), Negative ( ).
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   VI   Patellar tap: Positive ( ), Negative ( ).Crepitus: Audible ( ), Palpable ( ).Sandhi chalana:Flexion:Extension:External rotation:Internal rotation:Maana:Apparent shortening:True shortening:IX. ASHTASTHANA PAREEKSHA:i. Nadi: V / P / K / VP / PK / KV /VPKii. Mutra:iii. Mala: Drava / Baddha / Samyak / Othersiv. Jihva: Alipta / Alpa Lipta / Lipta / Othersv. Shabda: Praakruta / Vikrutavi. Sparsha: Prakruta / Vikrutavii. Druk: Prakruta / Vikrutaviii. Akruti: Prakruta / Vikruta
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   VII   X. DASHAVIDHA PAREEKSHA:1. Prakriti: V / P / K / VP / VK / PK / VPK2. Vikriti: a. Dosha : V / P / K / VP / PK / KV / VPKb. Dushya : R / Ra / Ma / Me / As / Mj / Sh / Other3. Sara: Avara / Madhyama / Pravara4. Samhanana: Avara / Madhyama / Pravara5. Pramana: Avara / Madhyama / Pravara6. Satmya: Avara / Madhyama / Pravara7. Satva: Avara / Madhyama / Pravara8. Aharashakti:Abhyavaharana:Purvatana: Avara / Madhyama / PravaraAdyatana: Avara / Madhyama / PravaraJarana:Purvatana: Avara / Madhyama / PravaraAdyatana: Avara / Madhyama / Pravara9. Vyayamashakti: Avara / Madhyama / Pravara10. Vayah: Yrs.
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   VIII   Part B – Interpretation NIDANA PANCHAKA:1. Nidana:Aharaja:Viharaja:Manasa:2. Poorva Roopa:3. Roopa:4. Upashaya /Anupashaya:5. SAMPRAPTI GHATAKA:Dosha: Dushya:Srotas: Dushtiprakara:Agni: Ama:Udbhava sthana: Sanchara sthana:Vyakta sthana: Roga marga:VYADHI VINISCHAYA:
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   IX   Treatment: Haritaki churna: Matra basti:    Part –C Diagnostic criteriaI. SUBJECTIVE PARAMETERS :SI.NO. PARAMETERS B.T. A.T. A.F.U.1. JANU SANDHI SHULA2. JANU SANDHI SHOTHA:3. ATOPA:4. STHABDHATA:5 PRASARANAAKUNCHANAYOVEDANA:6. SPARSHA ASAHYATA:Day: 1 2 3 4 5 6 7 8 9Date:Dose:Time:
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   X   II. ASSESSMENT CRITERIA: A. WOMAC SCALE:SI.NO. Details B.T. A.T. A.F.U.01 Walking on flatsurface:02 Going up anddown stairs:03 At night while inbed:04 Rest (sitting orlying):05 Standing upright:06 Morning stiffness:07 Stiffnessoccurring duringthe day:08 Ascending stairs:09 Descending stairs:10 Rising fromsitting:11 Standing:12 Sitting:13 Bending to thefloor:14 Walking on flatsurface:15 Getting in / out ofbed:16 Getting in / out oftoilet:17 Getting in / out ofbath:18 Light domesticduties:Grand total
  • A study on Jara w.s.r. to Role of Matrabasti in Janusandhigatvata  Dr.Kalyani Ashok Bhusane   XI   X-ray examination: RESULT:CONCLUSION:SIGNATURE OF RESEARCHER SIGNATURE OF CO-GUIDESIGNATURE OF GUIDE SIGNATURE OF H.O.D.   X-ray B.T. A.F.U.NormalMild changes ofO.AModerate changes ofO.ASevere changes ofO.A