A case report on the management of Akaala Jara with special reference to Premature Ageing

TK Sreejaya; Fareeda Begum Shaikh; Madhava Diggavi

A case report on the management of Akaala Jara with special reference to Premature Ageing

Sreejaya T.^1*, Shaikh F.², Diggavi M.³

DOI:

^1* TK Sreejaya, Post Graduate Scholar, Department of PG Studies in Kayachikitsa, Taranath Government Ayurveda Medical College, Ballari, Karnataka, India.

² Fareeda Begum Shaikh, Professor and Guide, Department of PG Studies in Kayachikitsa, Taranath Government Ayurveda Medical College, Ballari, Karnataka, India.

³ Madhava Diggavi, Professor and Head, Department of PG Studies in Kayachikitsa, Taranath Government Ayurveda Medical College, Ballari, Karnataka, India.

Akaala Jara is a condition where the Lakshanas of Jaravastha is seen in an earlier stage due to not following the proper conduct for health like seasonal Shodhana (elimination therapy), Dinacharya (daily regime) etc. Ageing is a set of progressive physiological changes in an organism often declining the biological functions and ability to adapt to metabolic stress. Due to the irregular dietary habits and faulty lifestyle, people are getting aged prematurely nowadays. A 50 years old moderately built female patient complains of Utsahahani (decreased enthusiasm), Nidra Viparyaya (defective sleep pattern), Sandhi Shoola (joint pain), Shakrutgraha (constipation), Prabhahani (loss of lustre), Dourbalya (weakness), Arohana Ayasa (exertional dyspnea), Karmahani (difficulty in doing activities) and Twak Parushyata (skin dryness) for 10 years got admitted in Kayachikitsa IPD, TGAMC. The case was diagnosed as Akaala Jara. Investigations of Hemoglobin, ESR, CRP, Serum Calcium added to the diagnosis. After Koshta Shodhana by Haritakyadi Yoga, Narasimha Churna in Palaartha Pramana (24g) was given for one month, along with Shudhabalataila Nitya Abhyanga. At the end of course of treatment, improvement was noted in all symptoms as well as in Hemoglobin, ESR, CRP, S.Calcium and photographs taken before and after treatment. Narasimha Churna having Bhallataka, Guduchi, Chitraka, Shunti, Pippali, Maricha are Ama Pachaka and Agni Dipaka. The drugs Shatavari, Guduchi, Shunti may compensate the reduction in Superoxide dismutase, catalase and lactase dehydrogenase promoting the antioxidant defense mechanism. While the Shudhabalataila Nitya Abhyanga pacify the Prakupitha Vata, Narasimha Churna might have done the Dhatwagni Dipana, Utharothara Dhatu Poshana leading to improvement in the condition.

Keywords: Akaala Jara, Case Report, Haritakyadi Yoga, Narasimha Churna, Premature Ageing, Shudhabala Taila

Corresponding Author	How to Cite this Article	To Browse
TK Sreejaya, Post Graduate Scholar, Department of PG Studies in Kayachikitsa, Taranath Government Ayurveda Medical College, Ballari, Karnataka, India. Email:	TK Sreejaya, Fareeda Begum Shaikh, Madhava Diggavi, A case report on the management of Akaala Jara with special reference to Premature Ageing. J Ayu Int Med Sci. 2022;7(4):121-126. Available From https://jaims.in/jaims/article/view/1799

Introduction

Ayurveda is the science with time tested testimonials of the traditional medicine since ages. It is unique in its own way of therapy and medicines. The science assures a healthy long life with the proper Dinacharya^[1](daily regime), Ritucharya^[2] (seasonal regime), Sadvritta^[3](good conduct) and Achara Rasayana.^[4] But in the present era, people are no longer following the same culture and traditions. Due to the irregular dietary habits and faulty lifestyle, individuals are getting aged prematurely nowadays. Mankind always aspires for a life without any difficulties which can be attributed to financial matter as well as health concern. The matter of health is utmost concern while looking in to the data of Dependency ratio of the elderly. An increase of nearly 34 million elderly persons was seen in 2021 over the population censes of 2011. The number is expected to increase by 56 million by 2031^[5]. But the age dependency ratio of the elderly has risen from 8.03% in 2011 to 9.773% in 2020^[6]. This can be an indicative of the fact that people are not coming across a healthy ageing. However, there is no available data regarding the Premature Ageing. Hence, there is a need to sort out this problem by a proper visionary and implementation of its solutions.

Jara is a Swabhavika Vyadhi^[7] (which is natural to occur) just like Mrityu (death), Kshuta (hunger) or Pipasa (thirst). The Jara is classified as Kaalaja and Akaalaja.^[8] Akaala Jara is a condition where the Lakshanas of Jaravastha is seen in an earlier stage due to not taking care of one’s own health.^[9] Ageing is a set of progressive physiological changes in an organism often declining the biological functions and ability to adapt to metabolic stress.^[10] Cells under aerobic condition are always threatened with the insult of Reactive Oxygen Species, which however are efficiently taken care off by the highly powerful antioxidant systems of the cell. When this balance is lost, oxidative stress occurs leading to various pathological conditions as well as Premature Ageing.

Objectives of the study

1. To evaluate the effect of Narasimha Churna and Shudhabala Taila Nitya Abhyanga in the management of Akaala Jara (Premature Ageing)

2. To improve the Quality of Life of an elderly.

Case Profile

A 50 years old moderately built female patient, house wife from Ballari was admitted in the Kayachikitsa IPD of Taranath Government Ayurveda Medical College and Hospital on 22^nd December 2021. Patient was complaining of Utsahahani (decreased enthusiasm), Nidra Viparyaya (defective sleep pattern), Sandhi Shoola (joint pain), Shakrutgraha (constipation), Prabhahani (loss of lustre), Dourbalya (weakness), Arohana Ayasa (exertional dyspnea), Karmahani (difficulty in doing activities) and Twak Parushyata (skin dryness) for 10 years which was gradual in onset.

History of Present illness: Patient was apparently alright 10 years back. Gradually started feeling loss of interest to do the daily activities in home. Patient also started experiencing difficulty in falling asleep in the night time. The number of hours in bed without sleep started increasing day by day since then. Gradually patient started getting pain in the joints. Initially it started with the knee joints but later on the passage of time it was seen in almost all the joints. Simultaneously developed with the difficulty in defecation which was seen very frequently. After afflicted by all these problems, patient lost the luster of face with an ill look which was precipitated by the weakness, exertional dyspnea, difficulty in doing activities over time. On detail interrogation, the patient was found to have dryness of the skin for 10 years. Patient have consulted many allopathic Doctors for the joint pain and was prescribed with NSAIDs and Calcium supplements. Later patient started self-medications of NSAIDs on and off. Patient neglected all the other symptoms for such a span of time. On 22^nd December 2021, due to the compulsion from the son, patient came for admission in Kayachikitsa IPD, Taranath Government Ayurveda Medical College and Hospital for the better treatment.

There was no significant family history and past illness. Patient have undergone the Hysterectomy 20 years back. The patient is a house wife with sedentary lifestyle, habituated to Vishamashana (irregular eating habits), Vegadharana (controlling of urges) and irregular exercise.

Past Medical History: Patient have a history of NSAID abuse due to the uncontrolled pain in joints. Patient was also taking nutritional supplementation for 20 years occasionally.

Clinical Findings

Vitals

Pulse: 72bpm, Heart Rate: 71bpm, BP- 130/80mmHg, Respiratory Rate: 18/min

The General physical Examination of the body pointed the BMI as 25.2 with the appearance of mild central obesity.

Systemic Examination

Examination of Respiratory, Cardiovascular, Central nervous System was found to be normal. The Per-Abdominal Examination pointed out the increased abdominal girth with no palpable organomegaly. Musculo-skeletal Examination revealed the joint movements to be painful and restricted. The Skin Ageing Score was determined based on the presence of wrinkles-superficial, crisscross and deep, Naso-labial folds, lax appearance, Solar elastosis, pseudo scar, Melasma, uneven pigment, Freckles seen in the patient.

Dashavidha Pareeksha

Shareera Prakriti was of Vata-Kapha and Manasa Prakriti was of Tamasa type. The Dosha involved was Vata Pradhana Tridosha. Patient was having Madhyama Pramana, Avara Sara, Madhyama Satwa, Pravara Satmya, Madhyama Samhanana, Madhyama Vyayamashakti, Madhyama Abhyavaharana Shakti and Avara Jarana Shakti. Patient exhibited the chronological age of Madhyama vayaska and Biological ageing of Vriddhavasta.

Investigations: The Blood tests showed the Level of Hemoglobin as 13.1g%, ESR as 42mm/hr, CRP as 18.9mg/dL and Serum Calcium as 7.6g/dL.

Apart from these, the patient was asked to do Sit-ups for one minute which was 12 and the time taken to walk a distance of 10 meters noted as 10 seconds.

Management Protocol

The patient was administered with Haritakyadi Yoga Churna^[11] for 5 days with which the Koshta Shuddhi Lakshanas were seen. It was then followed by Narasimha Churna^[12]24g empty stomach morning with Ksheera Anupana for one month which was accompanied by Abhyanga with Shudhabala Taila.^[13] The detailed protocol is shown in the Table no. 1

Table 1: The treatment strategy undertaken in the patient of Akaala Jara

Koshta Shodhana	Hareetakyadi Yoga	12g Churna with half glass (50ml) warm water After Food at night time	5 Days
Rasayana Prayoga	Narasimha Churna	24g OD with Ksheera (50ml), morning in empty stomach	30 Days
Nitya Abhyanga	Shudha Bala Tailam	100ml per day Abhyanga in 7 postures in the morning	30 Days
Total Duration of the Study			35 Days

Condition on Discharge

Patient previously interested to do daily chores only under pressure became interested to do all daily chores thus showing improvement in Utsaha (enthusiasm). The Sleep Efficiency Index improved from 70% to 100% after the course of treatment thus improving the Nidra (Sleep). Patient previously having joint pains even on medication started getting relieved by the medicines showing improvement in the Sandhi Shoola. Patient previously having dull face became adamant face with glow after the treatment improving the Prabha. Patient previously having frequent constipation was completely relieved after the treatment. The Arohana Ayasa (exertional dyspnea) and Dourbalya (weakness) which was seen frequently became occasionally after the treatment. The patient having difficulty in performing ventures before treatment became mild difficulty after the treatment improving the efficiency in doing Karma. The Twak Parushyata (skin dryness) which was seen always became frequently after the treatment. There is a reduction even in Skin Ageing Score which is graded as shown in Table No. 3. The Blood Reports also showed significant changes after the treatment as shown in the Table No. 2. The photographs of the patient before and after the treatment is shown in figure No.1.

Figure 1: Photographs of the patient before and after the treatment.

Table 2: Changes in the Blood Investigations and other Parameters before and after treatment.

Parameter	Before Treatment	After Treatment
Hemoglobin	13.1g%	14.1g%
ESR	42mm/hr	20mm/hr
CRP	18.9mg/dL	3.9mg/dL
Serum Calcium	7.6g/dL	12.8g/dL
No. of Sit-ups done by the patient in one minute	12	24
Time taken to walk a distance of 10 meters	10 seconds	9 seconds

Table 3: Changes in the features of Skin Ageing Score before and after the treatment.

Features	Before Treatment (Severity)	After Treatment (Severity)
Wrinkles - superficial	+ + + + +	+ + +
Wrinkles - deep	+ + + + +	+ + + + +
Wrinkles - criss cross	+ + + + +	+ + + +
Naso - labial folds	+ + + + +	+ + + + +
Lax appearance	+ + + + +	+ + + +
Solar elastosis	+ + + + +	+ + +
Pseudo scar	+ + + + +	+ + + +
Freckles	+ + + + +	+ + + + +
Melasma	+ + + + +	+ +
Uneven pigment	+ + + + +	+ + + + +

Discussion

Jara is a Swabhavabala Pravritta Vyadhi^[14] as mentioned by Acharya Susrutha. Since it is natural to occur, the treatment is considered to be ‘Nishpratyanika’.^[15] The commentator Dalhana emphasize it to be taken for the consideration of Rasayana Chikitsa. The indication of Rasayana Chikitsa is told for Purva Vayasi or Madhyama Vayasi.^[16] Here the patient having Madhyama Vaya is administered Rasayana with the prior administration of Haritakyadi Yoga for the purpose of Koshta Shodhana. The prime culprit of the disease Akaala Jara is Vata Dosha. Haritakyadi Yoga being the best Vatanulomaka does the Ama Pachana and Srotoshodhana which might improve the uptake of Rasayana by each cell of the body. The free radical chain breaking activity of Haritaki is already proven in previous studies.^[17]

Narasimha Churna is having the ingredients Bhallataka, Chitraka, Trikatu, Shatavari, Gokshura, Guduchi, Varahikanda, Vidarikanda, Tila along with Madhu, Ghrita and Sharkara. The Bhallataka, Chitraka, Trikatu with

the Agnidipana, Ama Pachana, Vatanulomana, Srotoshodhana properties correct the metabolism and cleanses the channels which might have reduced the Shakrutgraha (Constipation) and Nidra Viparyaya (irregular sleep pattern). The Shatavari, Gokshura, Vidari, Varahi, Tila owing to its Guru, Snigdha Guna does the Dhatu Poshana and Brimhana. The Guduchi with its Tridosha Shamaka Guna pacifies the Utklishta Dosha which might have reduced the inflammatory markers ESR and CRP as well as the Sandhi Shoola. Narasimha Churna collectively ensures the Dhatwagni Dipana and Utharothara Dhatu Poshana improving the Bala and quality of Ojus which might have improved the Utsaha, Prabha, Level of Hemoglobin, Serum Calcium, reduction in Arohana Ayasa and Karmahani. The Jarahara effect of Abhyanga is already established in the classics.^[18]

Shudhabala Taila with the Vatanashaka property rejuvenates the Neurons, improves the muscle tone and reduces the skin dryness which might have shown improvement in Prabha, walking speed, efficiency in doing sit-ups and reduction in Skin Ageing Score, Karmahani and Twak Paarushyata. The drugs Shatavari, Guduchi, Shunti may compensate the reduction in Superoxide dismutase, catalase and lactase dehydrogenase promoting the antioxidant defense mechanism. All the drugs of Narasimha Churna are having Anti-oxidant potentials as per the previous studies. Hence, it is expected to overcome the preponement of Ageing.

Conclusion

Premature Ageing is one of the major global health problems. In the absence of its complete cure, the potential risk factors can be reduced, timely diagnosis and early intervention can be administered. Ayurveda has clearly mentioned the occurrence of Akaala Jara (Premature Ageing) as the result of not taking care of one’s own health.

The Administration of Rasayana in Purva Vayasi or Madhyama Vayasi does the prevention of Kaalaja Jara. Here the Kaalaja Jara Pratibandhaka Rasayana has contributed to manage the Akaala Jara. To conclude, Akaala Jara if diagnosed in an earlier stage can be managed by the administration of Narasimha Churna and Shudhabala Taila Nitya Abhyanga. The case has shown encouraging results and there is a scope of further studies in this regard.

Reference

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9. Susrutha, Vyadhisamudheshiyadyayopakrama. In: Vaidya Yadavji Trikamji Acharya, editors. Susrutha Samhitha with Nibanda Sangraha Commentary of Dalhanacharya. Varanasi: Chaukambha Surabharati Prakashan; edition 2018. p.114-115.

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15. Susrutha, Vyadhisamudheshiyadyayopakrama. In: Vaidya Yadavji Trikamji Acharya, editors. Susrutha Samhitha with Nibanda Sangraha Commentary of Dalhanacharya. Varanasi: Chaukambha Surabharati Prakashan; edition 2018. p.114-115.

16. Susrutha, Sarvopaghata Prashamaniya Rasayanopakrama. In: Vaidya Yadavji Trikamji Acharya, editors. Susrutha Samhitha with Nibanda Sangraha Commentary of Dalhanacharya. Varanasi: Chaukambha Surabharati Prakashan; edition 2018. p.499.

17. Meher, Sudhanshu & Bhuyan, G.C. & Das, Banamali & Panda, Purnendu & Ratha, Kshirod. (2018). Pharmacological Profile of Terminalia

chebula retz. And Wild. (Haritaki) in Ayurveda with Evidences. Research Journal of Pharmacology and Pharmacodynamics. 10.115-25. 10.5958/2321-5836.2018.00023. X.

18. Vagbhata, Dinacharyadhyaya. In: Bhishagacharya Harishastri Paraadakara Vaidya, editors. Ashtanga Hridayam with the Sarvanga sundara commentary of Arunadatta and Ayurveda Rasayana of Hemadri. Varanasi: Chaukambha Orientalia; tenth edition,2019. p.26.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-04-04	2022-04-05	2022-04-12	2022-04-19	2022-04-26
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	16%

Case Report

Akaala Jara

Journal of Ayurveda and Integrated Medical Sciences