|Year : 2021 | Volume
| Issue : 2 | Page : 64-72
Effect of matravasti (medicated oil retention enema) as rasayana (rejuvenative therapy) in jarajanya vikar (problems of aging) - A clinical study
Sathya N Dornala1, Om Prakash Sharma2
1 Department of Panchakarma, Swami Vivekanand Ayurvedic Panchakarma Hospital, Dilshad Garden, Delhi, India
2 Department of Panchakarma, National Institute of Ayurveda, Jaipur, Rajasthan, India
|Date of Submission||16-Apr-2021|
|Date of Decision||12-Aug-2021|
|Date of Acceptance||01-Oct-2021|
|Date of Web Publication||29-Nov-2021|
Sathya N Dornala
#303, Satpura Tower, Kaushambi, Ghaziabad, Uttar Pradesh - 201 010
Source of Support: None, Conflict of Interest: None
Introduction: By 2025, there will be 1.2 billion older people in the world, close to three-quarters of them in developing countries, and the WHO estimates that India will have 11% of the total population of senior citizens. The chief aim of geriatrics is to “add life to years” rather than “years to life.” If Ayurvedic Rasayana therapy is applied in the true spirit, it is possible to achieve the desired goal. The tremendous potential of Ayurveda may be tapped for the benefits of day-to-day problems of geriatric patients, thereby offering greater and more viable scope for geriatrics in Ayurveda in the future. This study is an attempt in this direction. The objective of the study was to evaluate whether Matravasti shows multiple effects on different bodily systems (Rasayana) for the mitigation of aging-associated problems (Jarajanya vikara).
Materials and Methods: Eighty-two patients (56 males + 26 females) suffering from common problems of old age were registered for the study during December 2009 to December 2011 after having informed consent from them, out of which 16 patients (6 males + 10 females) were dropped out. The remaining 66 subjects were studied in detail. Matravasti was administered 21 times with Balashwagandhadi tailam (medicated oil) on alternate days with a dosage of 50–80 ml accordingly (approximately at 1 ml per kg body weight). After the completion of 21 sittings of Matravasti, posttest was done. All the patients were again reviewed after 6 months just to confirm the sustainability of the Matravasti effects. Fourteen clinical parameters involving different systems were considered for pretest and posttest assessment based on the available standard scales and self-rated scores to see the effect of Matravasti.
Results and Discussion: Among all clinical parameters considered for the study, maximum improvement was found in sleep disturbances (67.5%) followed by gait balance deficit (56.25%), emotional status (55.1%), urinary incontinence (55%), mobility (53.96%), instrumental activities of daily living (IADL) (51.3%), ADL (50.8%), constipation (49.5%), cognitive status (48.78%), pain (48.14%), dyspnea (47.25%), hearing impairment (42.5%), visual impairment (41.8%), dermatological manifestations (41.17%), and involuntary movements (22.2%). Patients also found a positive effect on their associated complaints such as hypertension, gastric troubles, loss of appetite, dementia, and parkinsonism.
Conclusion: The overall effect observed after this trial was Fair (25%–50% of improvement) in 38 cases, Good response (51–75% response) in 26 cases, and the Best response (>75%) in 2 cases. Moreover, the maximum benefit observed among all the cases was 81.8% and the least effect was 25%. After the study, it is evident that Matravasti, particularly with Balashwagandhadi tailam, shown multifaceted action (due to Rasayana property) and is a highly appreciated therapeutic measure in geriatric conditions.
Keywords: Aging, Ayurveda, Balashwagandhadi tailam, Jarajanya vikar, Matravasti, Rasayana
|How to cite this article:|
Dornala SN, Sharma OP. Effect of matravasti (medicated oil retention enema) as rasayana (rejuvenative therapy) in jarajanya vikar (problems of aging) - A clinical study. Indian J Ayurveda lntegr Med 2021;2:64-72
|How to cite this URL:|
Dornala SN, Sharma OP. Effect of matravasti (medicated oil retention enema) as rasayana (rejuvenative therapy) in jarajanya vikar (problems of aging) - A clinical study. Indian J Ayurveda lntegr Med [serial online] 2021 [cited 2022 Jan 19];2:64-72. Available from: http://www.ijaim.com/text.asp?2021/2/2/64/331486
| Introduction|| |
According to the United Nations World Population Prospects 2019, by 2050, 1 in 6 people in the world will be over the age of 65, up from 1 in 11 in 2019. All societies in the world are in the mid of this longevity revolution—some are at their early stages and some are more advanced, but all will pass through this extraordinary transition. This population aging has been recognized as one of the four global demographic “megatrends”—population growth, population aging, international migration, and urbanization. “Longer lives are not necessarily healthier lives” since the likelihood of disability increases with age.
aham hi dhanwantaradidevo jararujamrityuharoamarananam
The above verse clearly states that Ayurveda in itself has been evolved to ease human beings from Jara. Transformation is the hallmark of time. Everything that is living undergoes various changes before it is worn out completely. This cycle of changes in Ayurveda is termed as “Parinama” (transformation), which takes place under the constant influence of “Kala,” the time factor. Parinama, being aging, the sequential events of Bala (childhood), Taruna (adolescence), Youvana (youth), Prouda (adult), and Vardhikya (old age) are all consequential eventualities of Kala. Jara, being a Swabhavabala pravritta roga (naturally manifested diseases), occurs due to Vyadhi Hetu called Parinama/Kala. This dictum of Acharya Charaka should be understood in a sense that “Swabhava” cannot be avoided altogether; however, onset and manifestations of aging can be delayed to a certain extent, i.e., Manda Jara (a term specifically used in Ayurveda while enumerating the benefits of Sneha chikitsa). The very purpose of Rasayana is to minimize the rate of aging (Manda Jara) by impeding the degenerative process in the body so that aging effects may be delayed either by intensity or duration. In aged people, Vata Dosha is physiologically in a dominant state and the Rasadhi Dhatus is in a deprived state. This potent combination is responsible for the aged being submerged in a sea of multiple pathologies. From a doshic point of view, Vata Dosha is the key culprit in almost all geriatric problems since the basic features such as immobility, degenerative changes, and irritability are directly linked to it. Therefore, Vata shamaka chikitsa, i.e., Vasti and Snehana, is the primary aim of treatment. Considering this, the present study was carried out as a part of doctoral study in Ayurveda (Ph.D), with an objective to prove the efficacy of Matravasti with Balashwagandhadi tailam as Rasayana in aging-associated problems, i.e., to establish multifaceted effects of Matravasti on different bodily systems on clinical basis.
| Materials and Methods|| |
The study was approved by the institutional ethics committee (IEC) of the National Institute of Ayurveda, Jaipur, vide no. RAU/Aca/213/09-10. Eighty-two patients suffering from day-to-day aging problems were registered for the study after IEC approval.
The study design was nonrandomized single-group pretest–posttest multicenter study.
Patient sampling was done based on the inclusion and exclusion criteria given in [Table 1].
Source of the Data
Study subjects were recruited from three centers, viz., MCD Ayurvedic Dispensary, Krishna Nagar, Delhi; PG Department of Panchakarma, Madhav Vilas Hospital, Jaipur; and MCD Ayurvedic Panchakarma Hospital, Shahdara, Delhi.
Matravasti was administered 21 times on alternate days with 50–80 ml of Balashwagandhadi tailam (manufactured by Arya Vaidyasala Kottakal), procured from the open market. Ingredients of the Balashwagandhadi tailam are given in [Table 2]. The instruments required for Matravasti were disposable syringe (50 ml) with a rubber/plain suction catheter (6 n./16 no) and glycerin syringe (100 ml).
Method of administration of Matravasti
The procedure of administration of Vasti can be divided into three steps. (i) Preoperative procedure – The patients were instructed to come after a light diet (after breakfast during the summer season and after lunch during winters). They were also advised to come after attending natural urges. The patients were subjected to local massage on lower back and lower abdomen with mild fomentation for 5–10 min before the administration of Matravasti. (ii) Operative procedure – After preoperative preparation, the patients were asked to lie down in the left lateral position on the table. and to keep their left hand below the head as support. Sixty milliliters (approximately at 1 ml for 1 kg body weight) of lukewarm Balashwagandhadi tailam was loaded into syringe (Dispovan or Glycerin) and a rubber catheter was attached to the enema syringe and the tip of it lubricated with oil. After expelling the air from the enema syringe, the rubber catheter was inserted into the anus of the patients up to the length of 4 inches, and slowly, oil was administered into the rectum. The patients were asked to take deep breaths and to lie still while the catheter and the drug were introduced. (iii) Postoperative procedure – After the administration of Matravasti, the patients were advised to turn to supine position from left lateral position and both the legs were raised for few minutes so as to raise the waist and gently tapped over the hips and then asked to take rest in supine position with the arms and legs spread out freely over the table. Simultaneously, gentle taps were also given on lower abdomen, palms and soles so that the Matravasti would spread throughout the body and be retained for the required period. After some time, the patients were advised to get up from the table and asked to consume easily digestible foods only and also to avoid daytime sleep.
Fifteen assessment parameters (of which 14 clinical parameters and one investigation criteria – dehydroepiandrosterone [DHEA]) given in [Table 3] were chosen to evaluate the efficacy of the Matravasti on overall performance in older people.
|Table 3: Parameters designed to evaluate the overall performance in older people|
Click here to view
After completion of 21 sittings of Matravasti on alternate days, posttest was done, and all the patients were again reviewed after 6 months just to confirm the sustainability of the Matravasti effects.
Statistical analysis was done based on descriptive statistics such as percentage, standard deviation, and P value, using MINITAB software free version available online.
| Observations and Results|| |
Of 82 patients, 66 patients completed the study while 16 patients (6 males + 10 females) dropped out due to disinterest toward the route of administration. Demographic data of 66 patients with respect to age, sex, religion, economic status, dietary status, and addictions were studied considering the possibility of their influence on intervention outcome. Flowchart showing recruitment of the study participants, intervention, and the outcome is given in [Figure 1].
Of 66 cases, 54.54% belonged to the age group of 51–60 years while 31.81% belonged to the 61–70 years of age group; 75.75% were males as females showed disinterest toward the route of administration; 43.93% belonged to Hindu religion; 65.18% were from middle-income group. It was observed that 59.9% of the cases are graduates which helped in better participation in the questionnaire to assess the parameters before and after the therapy. 69.69% were complaining of constipation and were found to consume mixed diet; 37.87% were addicts and were suffering from mobility and balancing problems; 57.57% were of nuclear family which suggests a decrease in care and support for the aged; 63.64% were involved in religious activities which have been associated with better health status and health outcomes; 54.6% were living along with their spouse which may help in preventing and delaying aging psychosocial and physiological symptomatology. Of the entire 16 female patients, 50% attained menopause at 46–50 years of age.
Of all the 66 cases, 89.3% were complaining of constipation. This could be due to less fiber in the diet, reduced fluid intake and decrease in work activity, taking less exercise, and less effective movement of waste through the bowel due to a weakening of the bowel muscles and taking medicines. Less than 50% of cases are suffering from visual impairment, urinary incontinence, and hearing impairment. From >50% to 75% cases are suffering from dermatological manifestations, sleep disturbances, pain, dyspnea, involuntary movements, gait and balance, mobility, cognitive status, emotional status, and functional status. Conditions such as hypertension, gastric irritation, loss of appetite, dementia, and parkinsonism were few associated complaints.
Effect of Matravasti on clinical parameters
Activities of daily living
Both activities of daily living (ADL) and instrumental ADL (IADL) were considered to assess the functional status of the recruited geriatric cases. The effect of Matravasti was found to be beneficial in restoring ADL, with significant results both clinically (by 50.8% improvement) and statistically (P < 0.0001).
Instrumental activities of daily living
The effect of Matravasti was found beneficial in restoring IADL in patients, with significant results both clinically (by 51.3% improvement) and statistically (P < 0.0001).
The present study supported the evidence that Matravasti showed an impact on the mental status by promoting physical health and thus improving the quality of life and emotional well-being, with significant results both clinically (55.5%) and statistically (P < 0.0001).
After this therapy, it was found significant results in patients with cognitive status both clinically (48.78%) and statistically (P < 0.0001).
Mobility assessment before and after the therapy showed an interesting response with clinically significant improvement of 53.96%, and statistically, the same effect was highly significant (P < 0.0001).
Gait and balance deficit
After the therapy, response found was clinically significant by 56.25%, and statistically, the same effect was highly significant (P < 0.0001).
After this therapy, it was found encouraging results in involuntary movements both clinically (22.2%) and statistically (P < 0.0001).
Effect of Matravasti on dyspnea before and after its administration proved its efficacy, with significant results both clinically (47.25%) and statistically (P < 0.0001).
This therapy achieved a clinically significant improvement of 49.5% and with high statistical significance (P < 0.0001) in constipation of the aged.
The evaluation of pain by using brief pain inventory (BPI) was assessed before and after administration of Matravasti. This therapy achieved clinically significant results of 48.14% improvement and with high statistical significance (P < 0.0001).
The effect of Matravasti in relation to urinary incontinence before and after treatment was observed to be highly significant by 55% improvement clinically and statistically of high significance (P < 0.0001).
The evaluation of dermatological manifestations before and after administration of Matravasti was observed, which is clinically significant by 41.17% improvement and corresponding statistically highly significant (P < 0.0001).
After the therapy, it was found a remarkable change in sleep disturbances of aged, and the same was shown as highly significant both clinically (improvement by 67.5%) and statistically (P < 0.0001).
Assessment of visual impairment in aging individuals before and after the therapy has shown positive results by a mild improvement of 41.8% with a statistical significance (P < 0.0001).
After therapy, interesting changes were found in hearing impairment of the aged and the same was shown as highly significant both clinically (improvement by 42.5%) and statistically (P < 0.0001).
Effect of Matravasti on clinical parameters is given in [Table 4].
Due to high cost of the test, only 20 patients could able undergo the test procedure before and after the therapy. However, there is no change observed in values before and after the therapy.
| Discussion|| |
Old age affects the ability to perform and participate in ADL such as bathing, dressing, eating, toileting, standing/sitting, walking (around the house), and going outside the house. Matravasti with Balashwagandhadi tailam has a lubricating (because of sesame oil), balancing (presence of Bala in the oil), nourishing (due to Dadhi mastu), strengthening (because of Ashwagandha), and pacifying effect which relieves the spasticity of limbs and provides old age to develop, maintain, and restore maximum movement and functional ability (influence of Laksha). Without lubricating the muscles and joints of limbs with Matravasti, they will not get relaxed. The present study evidence found that the effect of Matravasti with Balashwagandhadi tailam found beneficial in restoring ADL.
IADL's such as ability to use telephone, shopping, food preparation, house-keeping, laundry, mode of transport, responsibility to own medications, and handling finances get affected due to old age. These screens are useful for indicating specifically how the patient is performing at the present time. This study revealed that Matravasti with Balashwagandhadi tailam found highly beneficial in restoring IADL of the patients, in comparison with ADL.
Depression is most common among disturbed mental health. The persons with disturbed emotional status cannot cope with the normal stresses of life and cannot work productively and fruitfully. The present study evidence supported that Matravasti with Balashwagandhadi tailam showed impact in mental status by promoting physical health and thus improving the quality of life and emotional well-being.
Some aspects of memory and other thinking abilities decline as a part of the normal aging process. Reduced cognitive functioning can lower one's quality of life and put their freedom at risk. Three-item recall MINICOG is the capacity for holding a small amount of information in mind in an active, readily available state for a short period of time. It is relatively uninfluenced by the level of education. Cognitive status was assessed before and after the administration of Matravasti with Balashwagandhadi tailam and was found to be highly significant.
Immobility is common in older people and may impact their daily life. Changes in mobility and abnormalities of gait increase with increasing age. Most of them may be musculoskeletal impairments. Disorders of the musculoskeletal system impair mobility, interfering with ADL and function. Improvement in mobility is possible in many instances, especially if the underlying etiologies are arrested early. From earlier studies, Basti found to be beneficial in osteoporosis usually seen in old age. The mobility was assessed with a self-designed severity scoring before and after the administration of Matravasti with Balashwagandhadi tailam, and the response is remarkable with clinically and statistically high significance.
Gait and balance deficit was assessed by performance-oriented mobility assessment (POMA) scale in which gait is assessed on the bare floor, asking the person to walk down a walkway, turn, and walk back. Balance is assessed by side-by-side standing balance. Normal gait is dependent on the integrity and interaction of three components, i.e., locomotion (including initiation, and maintenance of rhythmic stepping), balance, and the ability to adapt to the environment. With aging, deficits accumulate across one or all of these systems, reducing the locomotor capability of older adults. Few clinical studies reported that Matravasti was found beneficial in neurological problems such as sciatica. On assessment before and after the administration of Matravasti with Balashwagandhadi tailam, the response found was remarkable with clinically and statistically high significance.
The abnormal involuntary movement scale (AIMS) is a rating scale designed to measure involuntary movements of the patient's face, mouth, trunk, or limbs. The AIMS test consists of 12 items that assess spontaneous movements in different parts of the body. Falls are a common presenting characteristic of involuntary movements, which are also associated with gait irregularities and impaired mobility. Reviews on botanicals and procedures of Ayurveda found to be beneficial in neurological deficits related to old age. The evaluation of involuntary movements by using AIMS before and after the administration of Matravasti with Balashwagandhadi tailam revealed that this therapy found effective with a significant result both clinically and statistically.
Dyspnea is common among the elderly, is linked to poor health, and interferes with everyday activities. It's a known fact that, Older people are sensitive to added respiratory loads and their ventilator response to hypercapnia and hypoxia are reduced. The assessment of dyspnea reveals that after this therapy (Matravasti with Balashwagandhadi tailam), it was found significant results both clinically and statistically.
Constipation is a very common complaint among older persons. Matravasti with its multidimensional effect helps in drawing out feces, Kapha, Pitta, Vayu, and urine. It also provides relief in conditions such as distention of abdomen, flatulence, spastic colon, and dryness of digestive tract. Cases reported that Matravasti found beneficial in cases of chronic and refractory constipation. Matravasti with Balashwagandhadi tailam also provides the proper medium for the growth of the intestinal bacteria, particularly because of Dadhi mastu (prebiotic effect,), which relieves constipation.
BPI can be used as measures of pain severity and measures of pain interference. Pain severity is assessed by a questionnaire, to know the rate and intensity of pain, whereas pain interference is assessed by a questionnaire containing the relationship of pain with general activity, mood, walking ability, and sleep. Vata is the main cause of many pains including musculoskeletal origin or neurological origin. Earlier studies also established the effect of Vasti in osteoarthritis. Apart from this, the body constitution in old age is also Vata predominance which aggravates further. Hence, pain is a common problem of old age. Vasti is the principle line of treatment to pacify the aggravated Vata and Matravasti with Balashwagandhadi tailam proved clinically significant improvement and high statistical significance.
Urinary incontinence is the loss of bladder control. It is quite common and quite embarrassing as well. It may be of different types such as stress incontinence, urge incontinence, functional incontinence, and overflow incontinence. In old age, the muscles of pelvic floor and bladder get laxity causing incontinence. Matravasti helps in controlling urination by strengthening the smooth muscles, which in turn inhibit the involuntary contractions of the bladder and thus help to sense the bladder filling and benefit in delay voiding. The effect of Matravasti with Balashwagandhadi tailam in relation to urinary incontinence before and after treatment was observed clinically and statistically of high significance.
Dry, itchy skin is a common problem in aging adults. It was observed that long-term smoking adds to the aging of the skin. Skin becomes less oily, less elastic, and thinner as it ages. When sliced, it wounds quickly and takes a long time to recover. Matravasti with Balashwagandhadi tailam has the ability to moisturize skin, increases the skin elasticity, promotes luster by decreasing the dryness, and helps in recovery of the skin from damage, thus proving its efficacy clinically and statistically.
Most evidence indicates that as individuals approach old age, the amount of nocturnal sleep decreases; older individuals usually sleep only 6–7 h. Further, their sleep is more fragmented by wakefulness and is more susceptible to disruption by noise. Insomnia and restless sleep have a detrimental effect on mood, concentration, cognitive function, and memory, as well as causing balance issues that can lead to falls. It was observed that the patients who are suffering from pain are having sleep disturbances. Matravasti with Balashwagandhadi tailam helped in nourishing the channels and thus was found to achieve remarkable change and the same was shown as highly significant both clinically and statistically.
One of the most significant is visual impairment, which often worsens in the elderly. It can cause accidents and falls, with devastating consequences on the frailty of the older subjects. Visual impairment is usually a gradual deterioration over a long period. Matravasti with Balashwagandhadi tailam has a lubricating, balancing, nourishing, strengthening, and pacifying effect, and it also works as rejuvenator, immune-modulator, and nutrient and subdues elevated Vata Dosha.
Hearing impairment is one of the major health problems in old age. Since the ear is a very delicate organ, it can get damaged by different factors and lose its normal functioning. Damage to hair cells within the cochlea causes age-related hearing loss, resulting in inefficient transmission of electrical signals. It was observed in the study that men are more affected with hearing impairment than women. Sensory integration is the possible mechanism of Matravasti with Balashwagandhadi tailam that may have resulted in this effect.
DHEA-sulfate test measures the amount of DHEA-sulfate in the blood. DHEA-sulfate is a weak male hormone (androgen) produced by the adrenal gland in both men and women. Normal blood levels of DHEA-sulfate can differ by sex and age. Only 20 men had undergone the DHEA test. After therapy, it was found that there is no significant change in values before and after therapy.
Probable mode of multidimensional action of Matravasti in the modulation of aging symptomatology
From a doshic point of view, Vata Dosha is the key culprit in almost all geriatric problems. Ideal therapeutics for Vata pacification is Vasti karma and the drug of choice is Tailam. If both are used in combination, i.e., Tailam and Vasti (administration of oil into the rectum – intrarectal therapy), then there will be better clinical outcomes in Vriddha. Charaka advocated regular usage of Snehana benefits Manda Jara (slower rate of aging), Shatayu (hundred years of life span), and Buddhi indriya balaprada (promotion of intellect, senses, and strength). Sushruta has stated that the broad-spectrum effects of Vasti are mainly due to its spread in the body from Pakwasaya (large intestine) through appropriate channels in the same way, as water sprinkled at the root of the tree circulates all over the tree, because of Veerya of the drugs used. Bala,, Ashwagandha,, Laksha, Dadhi mastu, and sesame oil are the principal constituents in the oil chosen for Matravasti. They are highly praised adaptogens (Rasayana) for their influence on Mamsa dhatu (muscular tissue), Asthi dhatu (osseous tissue), and Ojas (immunity), all of which are reported to be affected significantly in old age. After this study, it was also found that the therapy had influencing effects on almost all the bodily systems. This multidimensional effect of Matravasti with Balashwagandhadi tailam in aging persons enabled them to lead full and active lives by the mitigation of debility and disability.
| Conclusion|| |
The overall effect observed after this trial was Fair (25%–50% of improvement) in 38 cases, Good response (51–75% response) in 26 cases, and the Best response (>75%) in 2 cases. Moreover, the maximum benefit observed among all the cases was 81.8% and the least effect was 25%. After the study, Matravasti, particularly with Balashwagandhadi tailam, is established as Rasayana due to its multifaceted effects on different bodily systems of aged people and is found as highly appreciated therapeutic measure in geriatric conditions. Review after 6 months of completion of therapy also confirmed the sustainability of the mitigating effects of Matravasti.
Since the United Nations declared the calendar year 1999 as the International Year of Older People, the problems of aging people got the worldwide focus. At this time, the whole world is rekindling its curiosity in the aging process and the elderly. In the first 50 years of the 21st century, old age dependency ratio is expected to double in more developed regions and triple in less developed regions; thus, the aged people are going to be a big problem for society. After understanding geriatric physiology, pathology, and corresponding symptomatology on a clinical basis before and after Matravasti and taking inputs from modern researches on biology and experimental physiology; Probable mode of multidimensional action of Matravasti can be hypothesized, that Matravasti modulates Vata via nitric oxide expression.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]