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
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 zsÉjÉqÉÉÇxÉÉ± 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×irÉÑÌlÉÍqÉ¨ÉeÉÉÈ| 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×Ì¨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. xuÉpÉÉuÉoÉsÉmÉëuÉ×¨ÉÉ 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 (eÉÏuÉlÉqÉÉ§ÉÇMüUÉåiÉÏirÉjÉïÈ|).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 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 “Í¤ÉrÉqÉÉlÉ kÉÉiÉÑ”(Su.Su.35/29). Ashtanga Sangraha also shares the same notion by stating ‘Í¤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 xÉuÉåïÎlSìrÉÉhÉÉqÉÑ±ÉåeÉMüÈ, 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 |kÉÉiÉuÉ¶ÉÉÍpÉuÉkÉïliÉå 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 mÉërÉÉåaÉÉ²wÉïzÉiÉqÉeÉUÇ cÉ uÉrÉÎxiÉ¸ÌiÉ”||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 xrÉÉ¨ÉiÉ§ÉÉÌlÉsÉÇ 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:“iÉxqÉÉÎŠÌMüixÉÉkÉïÍqÉÌiÉ 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 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.