Module on “Jara and Jarajanya Vyadhis: An Analytical Approach” By- Dr. Mangalagowri V Rao

JARA AND JARAJANYA VYADHIS: AN ANALYTICAL APPROACH

 

Upanishads emphasize on the principle of living for hundred years. In the ancient era the people had a long and healthy life because of their healthy food habits and lifestyle.

पश्येम शरदः शतम् ।।१।।जीवेम शरदः शतम् ।।२।। बुध्येम शरदः शतम् ।।३।। रोहेम शरदः शतम् ।।४।।

पूषेम शरदः शतम् ।।५।। (अथर्ववेद, काण्ड १९, सूक्त ६७)

Even in the classics of Ayurveda, there is reference in our Samhitas about chanting of Raksha mantra in the ears of new born for a long and healthy life. Earlier lot of stress was given to prevent Jara by devoting entire branch Rasayana/Jara Chikitsa including various types like Naimittika, Ajasrika etc Rasayanas. Presently world is drowning in fierce Psunami of chronic disorders making the life miserable even at an early age, further result in poor quality of life in old age and increasing burden of the society.

Importance of Rasayana

यथाऽमराणाममृतं यथा भोगवतांसुधा| तथाऽभवन्महर्षीणां रसायनविधिपुरा||७८||

न जरां न च दौर्बल्यं नातुर्यं निधनं न च| जग्मुर्वर्षसहस्राणि रसायनपराः पुरा||७९||

न केवलं दीर्घमिहायुरश्नुते रसायनं योविधिवन्निषेवते| Cha. Chi 1/78-79

As the nector is for immortality of amaras, Rasayana is nectar for sages in ancient times. By this there is no old age, no weakness, no disease, no death and the sages lived for thousands of years in olden days after consuming Rasayana drugs

Definition of Elderly

“Elderly” was once defined as being age 65 or above, but in the present scenario increasing elderly population has led to increase in active and healthy older people. Hence, it has been re- classified to “young old” (65 to 75), “old old” (75 to 85), and “oldest old” (85 and beyond). Geriatrics is another related term derived Greek word ‘geron’ meaning “old man” and ‘iatros’ meaning “healer”. Even though geriatrics is different from gerontology, the study of the aging process. Some consider, “Geriatrics” as “Medical Gerontology”.

Jara According to Ayurveda

xuÉpÉÉÌuÉMüÉxiÉÑ ¤ÉÑÎimÉmÉÉxÉÉeÉUÉqÉ×irÉÑÌlÉSìÉ mÉëM×üiÉrÉÈ iÉåÅÌmÉ Ì²kÉÉ II xÉÑ. xÉÔ. 1/23 II

The natural diseases comprise of hunger, thirst, old age, death, sleep etc. that occur naturally. They are of two types

eÉUÉÅÌmÉ rÉSÉÅMüÉsÉå pÉuÉÌiÉ xÉÉ mÉëM×üÌiÉrÉÉï II

Timely or ageing that sets in naturally and untimely or early onset ageing.

MüÉsÉM×üiÉÉlÉÉÇ lÉÉåÅmÉcÉÉUÉåÅÎxiÉ rÉmrÉiÉæuÉÉÎxiÉ pÉÉåeÉlÉmÉÉlÉUxÉÉrÉlÉÉÌSÍpÉÈ, AirÉÎliÉMü mÉëÌiÉMüÉUÉå uÉÉ II QûsWûhÉ II

There is no treatment for the natural ageing. However untimely or early onset ageing can be managed with diet and Rasayana or rejuvenation therapy.

Physiological changes due to ageing

oÉÉsrÉÇ uÉ×ήzNûÌuÉqÉåïkÉÉ iuÉaSØ̹ zÉÑ¢ü ÌuÉ¢üqÉÉæ I oÉÑÎ®È MüqÉåïÎlSìrÉÇ cÉåiÉÉå eÉÏÌuÉiÉÇ SzÉiÉÉå WØûxÉåiÉç II zÉÉ xÉÇ 1/6/20II

oÉÉsrÉÉuÉxjÉÉ SzÉuÉwÉÉïSÒmÉËU uÉ×ήuÉïkÉïlÉÇ Ì§ÉÇzɲwÉÉïSÒmÉËU zÉUÏUÇ cÉiuÉÉËUÇzɲUÉwÉÉïSÒmÉËU qÉåkÉÉ iÉÑ aÉëÇjÉÉMüwÉïhÉxÉÉqÉjrÉïÃmÉÉ mÉgcÉÉzɲwÉÉïSÒmÉËU iuÉMçü xÉÉ zÉæÍjÉsrÉÃmÉÉ pÉuÉiÉÏÌiÉ pÉÉuÉÈ wÉ̸ uÉwÉÉïSÒmÉËU SØÌ¹È xÉmiÉÌiÉuÉwÉÉïSÒmÉËU ÌuÉ¢üqÉÇ iÉŠ xÉÉWûxÉÉÌSÃmÉÇ mÉëÉ¢üqÉÇ xÉÇelÉqÉç lÉuÉÌiÉuÉwÉÉïSÒmÉËU oÉÑÎ®È zÉiÉuÉwÉÉïSÒmÉËU MüqÉåïÎlSìrÉqÉç SzÉÉÍkÉMüzÉiÉuÉwÉÉïSÒmÉËU cÉåiɶÉåiÉlÉxjÉÉlÉÇ ÌuÉÇzirÉÍkÉMüzÉiÉÇ mÉUqÉÉrÉÑqÉïlÉÑeÉÉlÉÉÇ pÉuÉiÉÏÌiÉ iÉimÉrÉÉïjÉïÈ

As per Acharya Sarangadhara, there is depletion of one factor in every decade of life. In first decade, there is loss of childhood, second decade growth, third decade lusture, forth decade memory, fifth decade skin i. e onset of wrinkles, sixth decade eye sight, seventh decade shukra, eighth decade valor, ninth decade intelligence or cognition, tenth decade strength of motor organ, eleventh decade energy and twelfth decade life respectively.

mÉgcÉÉzÉiÉ eÉUÉmÉcÉÏrÉqÉÉlÉzÉUÏU kÉÉiÉÔlÉÉÇ ¤ÉrÉÇ rÉÉÌiÉ zÉlÉæÈ CÌiÉ II xÉÑ. xÉÔ. 3/ 11 QûsWûhÉ II

Acharya Sushruta, opines that due to the impact of ageing there is gradual depletion of Dhatus and body.

Vatavriddhi in old age also leads to various dhatukshaya as per Ayurveda. The Rasakshaya can be related to dehydration as a symptom due to decreased renin activity and aldosterone secretion, relative renal resistance to vasopressin, changes in functional status, delirium and dementia, medication side effects, and mobility disorders and dehydration risk increases because of the kidney’s decreased ability to concentrate urine, altered thirst sensation.

The Mamsa kshaya can be compared with body composition changes as fat replaces muscle, in a process called sarcopenia in aged people. Research shows that exercise, particularly weight training, slows down this process. Because of the decrease in lean body mass, basal metabolic rate (BMR) declines about 5% per decade during adulthood. Total caloric needs drop, and lowered protein reserves slow the body’s ability to respond to injury or surgery. Body water decreases along with the decline in lean body mass.

SÉæoÉïsrÉÇ iÉÑ xuÉpÉÉuÉSÉåwÉeÉUÉÌSÍpÉUuÉåͤÉiÉurÉÇ II xÉÑ. xÉÔ. 35/35 II

Further, there is weakness naturally due to the process of ageing. Due to Vatavriddhi there is Asthikshaya. Asthikshaya can be compared with the Bone Mass Decreases due to ageing. Approximately 3%-5% bone mass decrease for each decade beginning at the age of 40. Further leading to Osteoporosis and increased chances of bone fractures.

Indriya daurbalya (weakness of sense organs) is again a feature of Jara. The researches show that the production of saliva is reduced, and taste buds decrease in size and number. The anterior taste buds, which are for sweet and salt, are affected first, whereas the posterior taste buds, for bitter and sour, are affected later. Therefore, older adults become more sensitive to bitter or sour flavors and less sensitive to sweet and salty flavors. These changes in the taste buds start at about age 70 on the average. The ability to smell usually decreases with age, the diminished senses of smell and taste may decrease the pleasure of eating. The changes in taste are variable and may be associated with lifelong cigarette smoking, poor dental hygiene, and disease.

Causes for depletion during Jara

xÉ LuÉɳÉUxÉÉå uÉ×®ÉlÉÉÇ mÉËUmÉYuÉzÉUÏUiuÉÉSmÉëÏhÉlÉÉå pÉuÉÌiÉ. xÉÑ. xÉÔ. 14/ 19

xÉ LuÉɳÉUxÉ CÌiÉ AzÉåwÉ kÉÉiÉÑ mÉÉåwÉMüÅÌmÉ uÉ×®ÉlÉÉqÉmÉëÏhÉlÉ DwÉiÉç mÉëÏhÉlÉÉå pÉuÉÌiÉ eÉÏuÉlÉqÉɧÉÇ MüËUÌiÉirÉjÉï: MÑüiÉÈ mÉËUmÉYuÉ zÉUÏUiuÉÉiÉç QûsWûhÉ

Acharya Sushruta mentions about the impaired absorption of ahara rasa in elderly people. Researches also show decreased absorption of nutrients like iron and calcium due to reduced secretion of hydrochloric acid to aid in digestion. Absorption of vitamin B12 is reduced due to decreased intrinsic factor. Decreased levels of production of gastric hydrochloric acid (HCl), intrinsic factor, and digestive enzymes results in a decrease in the primary building blocks needed for healing i.e. proteins, fats, and complex carbohydrates. This dysfunctional state also affects the body’s ability to absorb essential vitamins and minerals.

Agni in Jaravastha

ɪÉÉä½ýÉä®ÉÊjɦÉÖHúÉxÉÉÆ iÉä%xiɨÉvªÉÉÊnüMÉÉ& Gú¨ÉÉiÉÂ* iÉè¦ÉÇ´ÉäÊuü¹É¨ÉºiÉÒIhÉÉä ¨ÉxnüõÉÉÊMÉí& ºÉ¨Éè& ºÉ¨É&**8** Ashtanga Hridaya

One of the causes for depletion during Jara is considered as Vishamagni. As per modern researches also GI Motility decreases with age leading to constipation and gastro-intestinal distress, the patient may have feeling of fullness and eat less. Decreased gastric and pancreatic secretion inhibits fat and protein digestion. There is a decrease in glucose tolerance.

Relation between Agni and Jara

आयुर्वर्णो बलं स्वास्थ्यमुत्साहोपचयौ प्रभा| ओजस्तेजोऽग्नयः प्राणाश्चोक्ता देहाग्निहेतुकाः||३|| शान्तेऽग्नौ म्रियते, युक्ते चिरं जीवत्यनामयः| रोगी स्याद्विकृते, मूलमग्निस्तस्मान्निरुच्यते||४|| यदन्नं देहधात्वोजोबलवर्णादिपोषकम्| तत्राग्निर्हेतुराहारान्न ह्यपक्वाद्रसादयः||५|| अन्नमादानकर्मा तु प्राणः कोष्ठं प्रकर्षति| तद्द्रवैर्भिन्नसङ्घातं स्नेहेन मृदुतां गतम्||६|| समानेनावधूतोऽग्निरुदर्यः पवनोद्वहः| काले भुक्तं समं सम्यक् पचत्यायुर्विवृद्धये||७|| Cha. Chi. 15/3-7

The person will be endowed with longevity, complexion, strength, health, enthusiasm, lusture, ojas, temperature, life, are all dependent on Agni. If Agni becomes completely subdued, it results in death. If it is in good state leads to long life devoid of illness. If Agni gets vitiated it leads to disease. The ingested food is digested and nourishes the bdy after getting transformed into body tissue, ojas, strength and complexion. The food is brought to Koshtha by the help of Pranavata and gets broken down into smaller units and fats get digested in presence of Agni kindled by the Samana Vata. The timely consumed food gets digested well and leads to growth.

Pachakagni the leader of Agnis

अन्नस्य पक्ता सर्वेषां पक्तॄणामधिपो मतः| तन्मूलास्ते हि तद्वृद्धिक्षयवृद्धिक्षयात्मकाः||३९||  तस्मात्तं विधिवद्युक्तैरन्नपानेन्धनैर्हितैः| पालयेत् प्रयतस्तस्य स्थितौ ह्ययुर्बलस्थितिः||४०|| Cha. Chi. 15/39-40

Always the Jatharagni is the most important Agni. It is responsible for growth and depletion in the body. Hence, it should be maintained by means of intake of proper solid and liquid food as mentioned in the classics to promote strength and longevity.

Agni in Jaravastha

देशकालर्तुवैषम्याद्वेगानां च विधारणात्||४३|| दुष्यत्यग्निः, स दुष्टोऽन्नं न तत् पचति लघ्वपि| अपच्यमानं शुक्तत्वं यात्यन्नं विषरूपताम् ||४४||

The Agni gets deranged due to the consumption of food neglecting the factors like place, time, season, age, and suppression of natural urges. The deranged Agni, does not digest even the light food, and food gets fermented and gets transformed in to endotoxin.

Common geriatric ailments as per Ayurveda

जराशोषी कृशो मन्दवीर्यबुद्धिबलेन्द्रियः | कम्पनोऽरुचिमान् [१] भिन्नकांस्यपात्रहतस्वरः(नः) ||१९||

ष्ठीवति श्लेष्मणा हीनं गौरवारुचिपीडितः | सम्प्रस्रुतास्यनासाक्षः सुप्तरूक्षमलच्छविः || Su. U. 41/19-20||

The individual suffering from emaciation due to ageing is also afflicted with loss of strength, cognitive, sensory and motor functions, tremors, anorexia, sound simulating the striking of bronze vessel, expectoration of Kapha, and heaviness of the body, nausea, watering of eyes, numbness and dry lustreless look.

क्लैब्यं जरासम्भवं हि प्रवक्ष्याम्यथ तच्छृणु ||१७६||

जघन्यमध्यप्रवरं वयस्त्रिविधमुच्यते | अतिप्रवयसां शुक्रं प्रायशः क्षीयते नृणाम् ||१७७||

रसादीनां सङ्क्षयाच्च तथैवावृष्यसेवनात् | बलवीर्येन्द्रियाणां च क्रमेणैव परिक्षयात् ||१७८||

परिक्षयादायुषश्चाप्यनाहाराच्छ्रमात् क्लमात् | जरासम्भवजं क्लैब्यमित्येतैर्हेतुभिर्नृणाम् ||१७९||

जायते तेन सोऽत्यर्थं क्षीणधातुः सुदुर्बलः | विवर्णो दुर्बलो दीनः क्षिप्रं व्याधिमथाश्नुते ||१८०||

एतज्जरासम्भवं हि … |१८१| Cha. Chi 30/177-180

The erectile dysfunction and loss of libido occurs in males and females respectively with the advancement of age. The age is classified into three namely Jaghanya (early), Madhya (middle) and Pravara (elder). Generally, reduction of Shukra sets in among elderly due to Rasadi Dhatu Kshaya and intake of Avrishya diet. Gradually depletion of strength, potency, senses, longevity, due to malnutrition, physical exertion, mental tiredness, ultimately resulting in Klaibya in old age. There is also excessive depletion of Dhatus and the elderly suffers from weakness, loss of lusture, loss of energy and gets afflicted disease easily.

स्थविराणां जराकासः सर्वो याप्यः प्रकीर्तितः || Cha. Chi. 18/30 ||

The cough becomes incurable in elderly people.

Various health problems due to Vatavriddhi

Sandhigatavata (Rheumatic diseases e.g., osteoarthritis, rheumatoid arthritis, temporal arteritis/polymyalgia rheumatic), Pakshaghata (Neurologic diseases like stroke and transient ischemic attack,), Vatavyadhi (dizziness/syncope, body pain etc.) , Raktagata vata, Kampavata (Parkinson’s disease), as the age advances, Dementia immobility and gait disturbances, hearing and visual impairment Psychiatric diseases (e.g., depression), anxiety disorders, depression, elder abuse and neglect, suicide.

 

Multiple Choice questions

1. ‘……………..म्रियते, युक्ते चिरं जीवत्यनामयः’ the first word of this verse given in Charaka Samhita is
2. शान्तेऽग्नौ
3. मूलमग्नि
4. देहाग्नि
5. ओजस्तेजोऽग्नयः
6. Choose the right statement about stage of life and physiological predominance of Dosha
7. Balyavastha/ childhood – Pitta
8. Yuva avastha/ young age – Kapha
9. Vriddha avstha/ old age – Vata
10. Vriddha avastha/ old age – Kapha
11. According to ayurveda Jara is-
12. Swabhava bala privritta vyadhi
13. Aadhyatmik vyadhi
14. Aadhibhautik vyadhi
15. Dev bala bala privritta vyadhi
16. According to Acharya Sushruta gradual Dhatu Kshaya sets in by
17. More than 60 years
18. More than 50 years
19. More than 40 years
20. More than 70 years
21. According to Acharya Sharngadhara, the diminution in vision occurs-
22. After 40 years
23. After 50 years
24. After 60 years
25. After 70 years
26. In the old age group, what will be the suitable diet plan
27. Vata Nashaka and Dhatu Poshaka
28. Vata Vriddhikara and Dhatu Poshaka
29. Pittahara and Dhatuhrasaka
30. Guru, Santarpana and Agnimandyakara
31. Geriatric health care includes which components among the following
32. Rasayana therapy
33. Satvavajay chikitsa/ counselling
34. Diet and Yoga
35. All the above
36. Generally the status of Agni during old age is …………………….
37. Vishamagni
38. Mandagni
39. Tikshnagni
40. Samagni
41. According to Acharya Charaka the Kasa in old age is ……………………..
42. Sukha Sadhya
43. Kashta Sadhya
44. Yapya
45. None of the above
46. According to Ayurveda, during Jaravastha following changes occur
47. The impaired absorption of Ahara Rasa
48. Asthi Dhatu Kshaya
49. Functional loss of sense organs
50. All the above

 

Answer Keys

1. A
2. C
3. A
4. B
5. C
6. A
7. D
8. A
9. C
10. D

 

Links for further Reading

1. http://www.naturalmedicineoc.com/Reading%20Corner%20-%20Geriatric%20Care.htm (Geriatric Care)
2. 20Corner%20-%20Geriatric%20Care.htm  (Geriatric Nutrition: Encyclopedia of Nursing and Allied Health)

3. http://drabelson.com/Geriatric.html (Nutritional Support For Common Geriatric Conditions)
4. https://pubmed.ncbi.nlm.nih.gov/12002816/ (Role of saliva in the maintenance of taste sensitivity)
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791473/ (The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations)
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327232/ (The Physiology of the Gastric Parietal Cell)

1. https://academic.oup.com/jcem/article/86/12/5830/2849366 (Effect of Exogenous Cholecystokinin (CCK)-8 on Food Intake and Plasma CCK, Leptin, and Insulin Concentrations in Older and Young Adults: Evidence for Increased CCK Activity as a Cause of the Anorexia of Aging)
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442923/ (Sarcopenia: Aging-Related Loss of Muscle Mass and Function)
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731607/ (Translational physiology: from molecules to public health)
4. http://medicaljournals.stmjournals.in/index.php/JoAYUSH/article/view/1873 (Critical Study on Ahara with Special Reference to Geriatrics)