THE CONTEMPORARY STRENGTH OF AYURVEDIC ......Review Article THE CONTEMPORARY STRENGTH OF AYURVEDIC...

Review Article

THE CONTEMPORARY STRENGTH OF AYURVEDIC GERIATRICS

Ram Harsh SinghDept. of Kayachikitsa, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi.

E-mail : [email protected]

Abstract

Aging is an inevitable Swabhava of living being which is hallmarked with involution of the organism manifesting with a set of biologicalfeatures and incapacities. The old age is also frequently associated with preponderance of a set of illnesses specific to old age. As the incidence ofelderly people is rising in the population world over including India, it is now felt necessary to develop newer strategies for Geriatric health care.Ayurveda has discussed the issues related to Geriatric care and has projected a special branch of medicine called `Rasayana Tantra' to promotelongevity and good health through a range of life style measures, dietary care and use of rejuvenative remedies called Rasayana. Ayurveda has apotential to contribute substantially to this newly emerging branch of Medicine.

Annals Ayurvedic Med. 2012: 1 (1 & 2) 22-30

Key Words: Geriatrics, Rasayana, Pancha Karma, Ayurveda

INTRODUCTION

During last few decades there has been a noticeablerise in the average life expectancy of the people in Indiaand now there is an obvious shift in the age distributiondenoting population-aging. This has been overtly obviousin developed countries for several decades. Mostdemographers believe that a direct consequence of theongoing global fertility decline and decline of mortalityat elder ages is one of the most prominent globaldemographic trend of the 21st century which wouldinfluence the health status and socioeconomic patternworld-over. Population aging has been progressingrapidly in most of the industrialized countries of theworld but certain developing countries like China andIndia where fertility decline started late are nowexperiencing significant increase in the proportion oftheir elderly people. This trend is expected to continueover the next few decades. Population aging has manyimportant socioeconomic and health relatedconsequences including the increase in the old-agedependency ratio presenting challenges for public healthconcerns as well as for economic development due toshrinking and aging of work and labor forces riskingsocial security systems. The following table provides areflection of the rate of population aging in terms of thepercentage of elderly (>65 years) in the population ofsome major areas of the world (4-8).

Table 1: Observed and Forecasted percentages of theElderly (65+ years)

Countries /Regions

Year 1950 Year 2000 Year 2050

World 5.0 6.9 19.3

Africa 3.2 3.3 6.9

Latin America 3.7 5.4 16.9

China 4.5 6.9 22.7

India 3.3 5.0 14.8

Japan 4.9 17.2 36.4

Europe 8.2 14.7 29.2

USA 8.3 14.7 29.2

With the growing number of elderly individuals intoday's society the health problems of old age arebecoming more and more overt. Accordingly Geriatricsis emerging as a major medical specialty world over. InIndia too the last decade has projected significantly risingrate of population-aging and hence a great need is nowfelt to strengthen the geriatric care system in this fastdeveloping most populous country of the World.Conventional system of medicine has nothing much tooffer in the core area of geriatric care except the medicalmanagement of the diseases of old age.

On the contrary, Ayurveda is essentially the scienceof life and longevity. It presents a sound concept of aging,its prevention and management. Ayurveda specially

Annals of Ayurvedic Medicine Vol-1 Issue-1 & 2 Jan-Jun 2012 22

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Singh R.H. : Ayurvedic Geriatrics

incorporates Rasayana Tantra as one of its Astangaspecialties, which is exclusively devoted to nutrition,immunology and geriatrics. The present review intendsto evaluate the ancient concepts and recent developmentsin the field of geriatric care in Ayurveda.

THE DIMENSIONS OF GERIATRIC CARE

Geriatric Care has two distinct dimensions, No. 1.Promotion of health and longevity, No. 2. Managementof diseases of old age. The conventional modernmedicine is apparently strong in terms of the seconddimension, although the final outcome may not besignificant because most of the diseases of old age areincurable. Ayurveda is notably strong in terms of thefirst dimension of the problem as it has rich potential topromote health of the elderly, besides the scope ofrejuvenation and promotion of longevity. As statedearlier Ayurveda is essentially the Science of life andlongevity. The foremost classic of Ayurveda, the CarakaSamhita begins its deliberations in its very first chapterwith Deerghanjivitiya Adhydya.

THE PHENOMENON OF AGING

Aging is essentially a physiological phenomenonwhich results because of overwhelming of inherentevolutionary processes by the involutionary changesoccurring in the mind-body system. Such changes beginright in the beginning of life and get more and moreovert with advancing chronological age. The progressinginvolution ultimately precipitates into extremesenescence and finally death. Thus life-span is a time-bound entity and everybody is mortal. The main issue ingeriatric care is not merely the concern about thephysiological phenomenon which is inevitable, rather itis more the medical health problems and diseasesspecifically afflicting an individual in old age warrantingmedical management in order to sustain a comfortableand healthy aging. Thus geriatric care has to address totwo-fold problems, firstly the basic anti-aging care toretard the rate of physiological aging and secondly themedical management of diseases and disordersspecifically occurring in old age such as hypertension,ischaemic heart disease, diabetes, senile dementia,Alzheimer's disease, parkinsonism, degenerativearthritides, osteoporosis, opportunistic infections,prostatic enlargement, degenerative eye diseases like

cataract, a range of angiopathies, neurodegenerativediseases and senile psychoses which cause majormorbidity in old age.

Ayurveda, being fundamentally the science of lifeand longevity, seems to have addressed these issues inan unique holistic manner involving not merely thebiological care, rather also encompassing thepsychosocial and spiritual dimensions. There are strongpossibilities to develop a safe and cost-effective packagefor geriatric care on the basis of Ayurvedic life-stylemanagement, Rasayana therapy and practice of yoga.

As stated above, aging is an inevitable physiologicalprocess. Why senile changes occur in the mind-bodysystem, is not yet clearly known. Ayurveda considersaging as the Swabhava of life. In other words senescenceis the Swabhava or inherent nature of the living being,because the life is time-bound and it is inherently mortal.Ayurveda believes that aging occurs only in the bodyand mind, not in the real essence of the life, i.e. itsconscious component which is eternal and it onlychanges the body which is created by the Nature for onelife-span and ends there after through aging and death.Ayurveda considers Aging as the Jaivika Swabhawa i.e.biological nature of the living being and believes in thenatural cycle of birth-senescence-death-rebirth as thevery destiny of life. Hence what all is needed is to retardthe rate of aging to a limited extent and to promotehealthy aging. The Vedas too pray for a healthy long lifeof hundred years - Vivem saradah iatam, Paiyemsaradah iatam' and so on.

Western biosciences have been trying hard to identifythe causes of aging. A number of theories andobservations have been projected such as genetic theoryof aging, immunological theory, stress theory, freeradical injury, hormonal involution theory etc but noneof these have yet been proved. However, these researchesobviously indicate that aging is a multifactorialphenomenon. The genomic and immune mechanismsseem to be the sheet anchors. The following table enlistsvarious modern theories of Aging.

Table 2 : Various Contemporary Theories of Aging

1. The Wear and Tear Theory2. The Neuroendocrine Theory





3. The Genetic Control Theory4. The Free Radical Theory5. Waste Accumulation Theory6. Limited number of Cell Division Theory7. Hayflick Limit Theory8. Death Hormone Theory (DECO)9. Thymic -Stimulating Theory10. Mitochondrial Theory11. Errors and Repairs Theory12. Redundant DNA Theory13. Cross Linkage Theory14. Autoimmune Theory15. Caloric Restriction Theory16. Gene Mutation Theory17. The Rate of Living Theory18. The Telomerase Theory

Thus till date there is no fundamental contradictionbetween east and the west except the philosophy of time-bound life and rebirth and the splendid speculations aboutlife beyond death in oriental traditions.

According to Ayurveda aging and death are theSwabhava of life. However, a long healthy life has beenthe cherished wish of all beings, in all cultures andtraditions. Hence tremendous attempts have been madeto prolong life and to sustain healthy aging. Ayurvedalinks the phenomenon of biological aging with thedoctrine of Tridosa. In principles the childhood isembedded with Kapha in the body, adulthood with Pittaand old age with Vesta Dosa. Vesta Dosa, by nature, driesand decays the body and produces senile changes. Thusthe phenomenon of aging can be evaluated in terms ofthe tridosika physiology, and aging can be managed intune with the Tridasa theory with Yukti of Samanya andVisesa i.e. homology versus heterology besides specificrejuvenative Rasayana measures (2,19-21).

Age Span Trido§ic Dominance Dominant Bio-Activity

Young Age Kapha Predominant Growth Activity

Adult Age Pitta Predominant Metabolic Activity

Old Age \Tata Predominant Degenerative Activity

The important medieval Laghuttrayi text ofAyurveda, namely Sarangadhara Samhita describes theprocess of aging depicting the involutionary features ofspecific bio-losses occurring during different decades

of life due to aging (9,16,21). These descriptions are relevanteven today if the chronology is corrected with presentlife-span of man (1). This is specially significant becauseit can provide a guideline for selection of age-specificorgan-protective Rasayanas to restore the age-relatedbiolosses during different decades of the life span as ameasure to retard aging. Few examples are cited in thefollowing table.

Table 3: Sequential bio-losses during aging & restorativeRasayanas

S.No.

Decades Age related bio-losses Restorative Rasayanas

1. 0-10 Loss of Corpulence Vaca, Gambhari

2. 11-20 Loss of Growth Amalaki, Bala

3. 21-30 Loss of Lusture Haridra, Kumari, Louha

4. 31-40 Loss of Intellect Sankhapuspi, Bralimi

5. 41-50 Loss of Skin glow Kumari, Somaraji

6. 51-60 Loss of Vision Triphala, Jyotismati

7. 61-70 Loss of Virility Kapikacchu,Agwagandha

8. 71-80 Loss of Strength Amalaki, Bala, Pravala

9. 81-90 Loss of Cognitivepower

Brahmi, Mandakapartti

10. 91-100 Loss of Locomotiveability

Amalaki, Bala,Agwagandha

Other important features of aging process are weakeningof Agni, loss of integrity of Srotamsi and ojabala. Hencegeriatric care warrants management of Agni, Ama andOja dosa2 at biological level. Ayurvedic classicspropound an unique concept of Ojas which is the essenceof all Dhatus .3 It is of two types namely 1. Para-ojaswhich is in minute quantity located in the heart and isvital for life; if Para-ojas is hurt, instantaneous deathfollows. 2. Apara-ojas which is relatively gross, is spreadall over the body and is generally responsible for immunestrength or Ojabala. Ojabala is considered to be of threecategories ,4 viz. 1. Sahajabala or primary naturalimmunity, 2. Kalajabala or acquired natural immunity,3. Yuktikrta or artificially induced immunity. InAyurveda Ojabala forms an important consideration inthe process of aging. Besides many other life-style relatedfactors the generic remedy prescribed for promoting Ojas





status is Rasayana therapy. All Rasayanas are belovedto promote ojas.

BRAIN AGING AND MEDHYA RASAYANA:

In the context of aging the brain happens to be animportant consideration. Besides general features ofbiological aging which occurs all over the body in allorgans, tissues and cells, the brain seems to be the majorfocus of such changes. This is why the mental andneurological manifestations often form the hallmark ofsenility. Accordingly the care of neurodegenerativemanifestations warrants the first attention in geriatrichealth care. Ayurveda seems to have understood this factand has categorically described the psyche-brain deficitoccurring in the fourth and ninth decades of the hundredyears life-span in terms of loss of Medha and Buddhi.

In terms of the science of today human brain is ahighly sophisticated structure, its basic functioning units- the neurons are known to be energetically mostpowerful units but have extremely poor repair andregeneration potential and hence are prone to rapidsenescence and degenerative changes.

The Ayurvedic classics and yogic texts describe aset of rejuvenative measures to impart biologicalsustenance of the bodily tissues, i.e. the Dhatus. Theseremedies are called Rasayana and are claimed to act asmicronutrients. Though, the Rasayanas are genericrejuvenative remedies, some of them are specific to Brainand nervous system and are called Medhya Rasayana.Certain recent scientific studies have revealed thatMedhya remedies of Ayurveda could prove to be apotential source for developing a new class ofneuronutrients with cognition and memory enhancing,antiaging and neuro-regenerative effect. Studies onBrahmi (B. monniera), Mandukaparni (C. asiatica) andAlwagandha (W.somnifera) are interesting.

Ayurveda considers aging as an inbuilt naturaldisorder. Slarangadhara (1300 AD) while describing thesequence of aging suggests that Medha, i.e. intellect stops

growing by Fourth decade of life and Buddhi, i.e.

thinking is lost by Ninth decade reading to seniledementia in a person of stipulated 100 years life span.

Brahmi (B.monniera) is now established as a memory

enhancer and has therapeutic role in the management ofaging brain and senile dementia. Mandukaparni (C.asiatica) is now used in the care of mental retardationand probably helps mentally retarded children as aneuronutraceutical and as a remedy presumably actingthrough Srotopromoting effect and enhance cerebralblood flow. Aiwagandha (W. somnifera) is anestablished antistress and adoptogen besides its efficacyin augmenting neuro-regeneration. Tomoharn Kuboyama

et. al. (2005) reported neuritic regeneration and synopticreconstruction induced by withanolide-A isolated fromAfwagandha. All these studies open newer vistas ofinvestigation in Neuroscience of today particularly inthe area of Neuronutrition.

THE RASAYANA THERAPY AND ITS MODE OFACTION:

Rasayana (Rasa = nutrition + Ayana = circulationand promotion) specially deals with the science ofnutrition, geriatric care and rejuvenation. Rasayanasignifies not a single drug or medication, rather refers toa rejuvenative regimen which of course uses rejuvenative

remedies or drugs, dietetics and overall healthy life-styleand positive psychosocial conduct. The use of Rasayanameasures and remedies produces best qualities of Dhatus,

i.e. body-tissues by acting through one or all of thefollowing three principal levels of biological system with

net result of improved nutritional status leading, in turn,to better qualities of tissues, longevity, immunity,resistance against disease and improved mental faculties.The primary levels/modes of Rasayana effect are (3,11,16-18):

1. At the level of Rasa (Promoting directly thenutrient value of plasma),

2. At the level of Agni (Promoting biofire systemresponsible for digestion and metabolism)

3. At the level of Srotas (Promotingmicrocirculation and tissue perfusion)





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CLASSIFICATION OF RASAYANA:

(1) As per scope of use :

(A) Kenya Rasayana - which is used in healthypersons for further promotion of health. It is again ofthree subtypes :

(i) Pre:ia kamya to promote longevity.(ii) Srikeunya to promote body lusture.(iii)Medha kamya to promote mental competence

(B) Naimittika Rasayana which is used specificallyin the treatment of specific diseases viz Silajatu indiabetes mellitus.

(2) As per method of use :

(i) Veitatapika Rasayana i.e. outdoor regimen.(ii) Kutipraveiika Rasayana i.e. intensive indoor

regimen including biopurification byPancakarma and consumption of selectedRasayana in well controlled conditions.

(3) As part of life-style :

(i) Ajasrka Rasayana as content of daily diet.(ii) Acara Rasayana i.e. Rejuvenative healthy life

style and conduct.(iii)Divya Rasayana i.e. devine Rasayana

TISSUE AND ORGAN SPECIFIC RASAYANA:

Besides the above mentioned three generic modesof action of Rasayana, some Rasayanas are organ andtissue specific and are used for specific indications likeMedhya Rasayana as brain tonics, Hrdya Rasayana ascardiotonics, Vrsya Rasayana as sex tonics, TwacyaRasayana as skin tonics, Stanya Rasayana as lactogenictonics, Keiya Rasayana as hair tonics, CaksusyaRasayana as eye tonics, Kanthya Rasayana as tonics forthroat and speech and so on.

DISEASE SPECIFIC RASAYANA:

Some Rasayanas are also disease-specific and areused in specific disease states as they induce specificimmune and bio-strength to combat a particular disease.Such Rasayanas are called Naimittika Rasayana. Theclassical Naimittika Rasayanas are Silajatu for diabetesmellitus and Tubaraka for skin diseases and leprosy.There can be many other Naimittika Rasayanasidentifiable by proper yukti.

AGE SPECIFIC RASAYANA:

Some Rasayanas are also age-specific and can beprescribed for particular age groups. As stated earlierAyurveda describes the qualities of each decade of the100 years of estimated life-span. During the process ofaging an individual goes on loosing these age-relatedbio-qualities and if this loss is compensated by age-specific Rasayana in specific age groups the rate of agingcan be retarded to some extent and one can promotelongevity. The decade-wise bio-losses described bySarangdhara and Vagbhatta are as mentioned earlier intable-3 with suggested Rasayana remedies to compensatethe losses.

METHOD OF ADMINISTRATION OFRASAYANA

The Rasayana therapy is administered in two broadforms with two main objectives. Firstly as outdoorregimen (Vatatapika Rasayana) for ordinary routineRasayana benefits as a tonic or food supplement.Secondly as an intensive indoor regimen (KutipreadikaRasayana) for Rejuvenation or Kayeikalpa, where thepatient is confined in a specially designed TrigarbhaRasayana Kuti i.e. a well protected therapy chamber





equipped with all therapeutic amenities. In the latter casethe patient first undergoes a biopurification therapy byPanca Karma (15). After Panca Karma he consumesthe suitably chosen Rasayana for him in a prescribeddose and duration along with the prescribed dietetics(Ajasrika Rasayana) and the appropriate life-style andconduct (Accra Rasayana). Rasayana administeredwithout proper biopurification and without the Ajasrikaand Accra requirements, may not yield adequate results.

The main Rasayana drug/remedy is prescribed for aclient/patient in consideration of a range of factors viz.

1. Age and rate of aging in consideration of theten sequential bio-losses related to different decades of100 years life span as mentioned earlier in table 3.

2. Prakrti or constitution i.e. Dosa Prakrti,Manas Prakrti

3. Satmya or Adaptability in relation of the Dejaand Ka la i.e. climate, season and weather.

4. Disease state - The Tridosika nature of theaccompanying disease, if any, in consideration of asuitable Naimittika Rasayana.

5. Physiological considerations, particularly thestate of Dheitus, Ojas, Agni and Agni Bala.

The Rasayana Effect and Rejuvenation

The Rasayana remedies described in Ayurveda areclaimed to possess special nutritional supplement effect.Generally most of the Rasayanas are micromolecularnutrients and they act through nutrition dynamics andnot really on pharmacodynamics like other drugs. TheRasayana drugs are likely to be nutrient tonics, anti-oxidants, anti-stress, adaptogen and immuno-modulators.The net effect of all these attributes is the anti-agingeffect. Certain recent studies on popular Rasayanaremedies like Amalaki, Aiwagandha, Gudaci, Brahmiand classical compound Rasayana Cyavanapraa haveshown evidence to suggest their efficacy as anti-agingremedies. The following tables are being reproducedfrom earlier studies to give a glimpse of such an evidenceabout sone popular Rasayana drugs like Ahvagandha,Tulasi and Ginsen (1.3.10).

Table 4. Anti-stress activity of some Rasayanas in terms of Ed 50 in stressed rats, Singh N 1987

Drugs Tested SwimmingperformanceAdrenal wt.

Prevention ofAscorbic acidrise

Prevention ofAdrenal cortisolrise

Prevention ofstress ulcers

Antistress unitmg/g

Agwangandha 15.0±1.3 13.0±1.4 14.5±1.5 16.0±1.8 14.9±1.5

Tulasi 13.3±1.2 12.0±1.6 13.0±1.5 13.42.0 13.7±1.3

P. ginsen 44.0±3.8 15.0±1.8 24.1±2.1 24.07±2.2 25.2±2.3

Table 5. Effect of Agwagandha on plasma corticosterone, phagocytic Index and swimming enduranceundernormal and stress conditions (Archana 1999)

ObservationsMean a SE

Control Agwangandhatreated

Stress(Swimming)

Swimming Stress +Agwangandha

PlasmaCorticosterone µg /dl

98.95±0.51 98.95±0.27 107.2±0.38 99.77±0.14 p<0.05

Phagocytic Index 68.50±0.56 69.60±0.70 78.0±0.58 68.83±1.20 p<0.05

Total Swim Time - - 5.30±0.2 48.90±0.50 p<0.05





Table 6. Biological Age Scale (BAS) and Brief Psychiatric Rating Scale (BPRS) Scores before and aftertreatment with Agwagandha (Dwivedi and Singh, 1997)

Observations Before Treatment After Treatment t PTotal BAS Scores 18.77± 4.55 14.20± 4.37 2.92 <0.01

Total PBRS Scores 32.40-, 5.22 22.93± 2.86 6.12 <0.01

The above cited observations indicate that theRasayana drug Aiwagandha has significant anti-stresseffect on notably lower effective dose (Ed50) ascompared to popular Chinese herbal tonic Ginsen.Aiwagandha also shows relevant humoral basis for itsanti-stress and anti-inflammatory effect. The clinical trialof Aiwagandha in elderly volunteers shows significantreduction in the rate of Biological Aging (BAS) andmental health status as measured by BPRS (Table 4-6).There are several such studies conducted on manyRasayana drugs.

Geriatric Panchakarma Therapy

Ayurveda practices an unique approach of bio-purificatory therapy designed to cleanse the Srotamsii.e. the micro channels of the body enabling the organismto function normally and also to restore the innertransport system resulting in turn to better nutritionalstatus with adequate chances of repair of wear and tearof the body with rejuvenative activity. In geriatricpractice an Ayurvedic physician uses selectiverehabilitative Panchkarma therapy avoiding the drasticevacuatory practices like Vamana and strong Virechanaprocedures. The schedule in the elderly should consistof medicated massage, sudation, Kayaseka, Pindasweda,Sirodhara and Brimharja Basti suitably planned for eachindividual. Such a package could appropriatelyconsidered 'Geriatric Pancakarma'.

Ayurvedic Management of Diseases of Old Age

Besides the rejuvenative approaches Ayurveda hasnotable potential to afford significant complementarytherapeutic care in a range of diseases of the elderly andthe same needs to be known to the practicing physiciansof all streams. Arjuna, Guggulu and Puskarmula ascardiprotectives in cases of Ischaemic heart disease,Brahmi and similar other Medhya drugs in treatment ofsenile dementias, Varuna and Sigru in treatment of senile

enlargement of Prostate, Triphala in senile visualdisorders, Kapikacchu in treatment of Parkinsonsdisease, Amrita and Amalaki in immunodeficiency,Sirodhara and Sirobasti in tension headaches anddifferent kinds of neurodegenerative conditions are someof the potential areas where Ayurvedic treatment haspromise. Similarly the Pindasweda procedure of KeraliyaPanchkarma therapy is known for its rehabilitative effectin many neurodegenerative conditions and myopathies.

A Suggested Package of Geriatric Care

The Ayurveda-based package of geriatric care mayconsist of :

1. Recording of the Prakrti, Vaya, Agni & Ojasstatus, Deia-Kola, Vyadhi and overall health statusto help in planning the geriatric care.

2. Swasthavrtta & Sadvrtta i.e. codes of personal andsocial hygiene.

3. Dietary care avoiding too much of fat and heavyproteins preferring easily digestible nourishingsattvika diet.

4. Regular exercise according to Vyayama-Sakti.5. Regulated rest and relaxation6. Yoga and meditation7. Geriatric Panca karma Therapy.8. Rasayana therapy prescribed in consideration of

individual needs considering the findings recordedunder item 1 mentioned above.

9. Medical management of associated age-relateddiseases if any.

10. Supportive therapy and socio-economic supportand care of social and spiritual health.

COMMENTS AND CONCLUSIONS

Population-Aging and the increasing number ofelders in the population is a matter of great significancebecause of its likely impact on public health andsocioeconomic growth of a nation. Ayurveda, being the





science of life and longevity, offers a treasure of geriatriccare (12-14). It deliberates on the science and philosophyof life and longevity with the goal of healthy aging andlong life to achieve the Purusartha catustaya - Dharma,Artha, Kama, Mokya. It considers aging as Swabhava oflife and describes in details the pattern of sequentiallosses of biological strength with advancing age inrelation to the doctrine of Tridosa and advocates themanagement of aging and diseases of aging on principlesof Samanya and Viiesa (Homology versus Heterology).The central focus of strength of Ayurveda in geriatriccare swings around the concept of Rasayana therapywhich compensates the age-related biological losses inthe mind-body system and affords rejuvenative effect toa notable extent. Combining Ayurvedic Rasayana,rehabilitative Panchkarma therapy dietetics,Swasthavrtta, Sadvrtta, Yoga and spirituality it ispossible to develop an effective package for geriatriccare today for global use. There is a need to generateawareness among the masses about the consequences ofPopulation-Aging and about the strength of Ayurvedain Geriatric health care. It is a matter of great satisfactionthat the Department of AYUSH, Ministry of Health andFW, Govt. of India has launched a national campaign topopularize the strength of Ayurveda, Siddha and Yogain geriatric health care.

REFERENCES:

1. Archana, R. and Namasiwayam, A. (1999),Antistress effect of Withania somnifers. J.Ethnopharmacol. 64: 91-93.

2. Caraka (700 BC), Caraka Samhita, Ed Sharma P.V.,Cikitsa Sthand Chapter I, Choukhamba Orientalia,Varanasi.

3. Dwivedi, K.K. and Singh, R.H. (1997), A study ongeriatric patients and response of Agwagandha as antiaging agent. Ph.D. Thesis Kayachikitsa, BanarasHindu University.

4. Kinsella, K and Victoria, A.V. (2001). An AgingWorld: 2001. U.S. Census Bureau, Series P 94/011, Washington, DC.

5. Lutz, W; Warren, S. and Sergei, S. (2001). The endof world population growth. Nature 412: 543-545.

6. Paul, D. and Geoffrey, M (2003). The Encyclopediaof population, New York, Macmillan reference,USA.

7. Preston, S.H.; Christine, H. and Mitchell, E. (1989).Demographic conditions responsible for populationaging. Demography 26: 291-704.

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garangadhara (1300 AD), garangadhara Samhita PartII Chapter 6, vs. 20.

Singh, N. (1987), Study of Antistress effect of plantdrugs. Ann. Acad. Ind. Med. Vol 1, No. 1.

Singh, R.H. (1998), The holistic principles ofAyurvedic Medicine, Chapter 8. ChoukhambaSurbharati, Varanasi New Delhi.

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Singh, R.H. (2005), Advances in AyurvedicMedicine Vol 1-5. Choukhamba Vishwabharati,Varanasi.

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16. Singh, R.H. (2005), Swasthavrtta Vijynana, Chapter3, 4, 7, 22-23, Choukhamba Surbharati, Varanasi.

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18. Singh, R.H. (2008), Strength of Ayurveda in GeriatricHealth Care. Keynote lecture delivered at Statelaunching of National Campaign on Geriatric HealthCare through Ayurveda, Dept. of AYUSH, Govt. ofIndia, New Delhi.





19. Sugruta (600 BC), Susruta Samhita, Ed. Singhal &Associates, Cikitsa Sthand Chapter 27-30,Choukhamba Surbharati, Varanasi.

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21. Vagbhatta (300 AD), Astanga Hridaya Uttara Tantra,Rasayana Chapter, Choukhamba Publications,Varanasi.

Source of Support: NilConflict of Interest: None declared




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