[J. Res. Ind. Med. Yoga and Homoeo, (1979): 14, 2, 45] Further Studies on the Effect of an Indigenous Compound Rasayana Drug on Physical and Mental Disability in Aged Persons Singh, R.H. Reader in Kayachikitsa, Institute of Medical Sciences, B.H.U., Varanasi, and Sinha, B.N. Lecturer in Kayachikitsa, A. and U. Tibbia College, New Delhi. (Psychosomatic Medicine and Rasayana Clinic, Dept. of Kayachikitsa, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. Ageing brings about a progressive mental and physical disability in man. It is known that depending upon the genetic make-up of an individual and a number of environmental factors, the rate of ageing varies widely. This indicates the possibility that the onset of physical and mental disability can be postponed. Accordingly, efforts have been made in modern medicine to retard the process of ageing but none of such efforts have shown promising results. Thus modern geriatrics remains only a non-medicinal care-taking discipline for aged persons. On the other hand, the Indian system of medicine has been practising well developed geriatrics under Rasayana Tantra since antiquity. Rasayana Tantra forms one of the eight clinical specialities of Indian medicine, the Astanga Ayurveda. According to Ayurveda, a 'Rasayana' is a therapeutic agent or a dietary factor, which influences the nutritional value of plasma, vitalises digestion and metabolism and improves microcirculation and tissue perfusion. By producing such fundamental changes, a Rasayana agent induces longevity and immunity in an individual and improves his mental power. Thus Ayurveda conceives the possibility of producing fundamental physical and mental changes in man by the use of Rasayana agents leading to prolonged healthful life. 'Geriforte' of The Himalaya Drug Co. is a comprehensive compound of Rasayana drugs. The major component of this compound is the famous Ayurvedic tonic Chyavanprash. Besides, this compound contains some important Medhya Rasayana (nervine tonic) drugs like Brahmi, Asvagandha etc. We have already studied the beneficial effects of Chyavanprash (Varma et al, 1973), Brahmi (Singh, 1977) separately. These drugs were found to possess significant beneficial effects on the body and the mind in aged and anxious persons. In view of the above observations it was considered useful to evaluate the clinical efficacy of the compound, 'Geriforte'. Our preliminary studies on this compound (Singh and Sinha, 1978) have shown anti-anxiety and restorative effects in this drug. The present studies have been conducted on a larger series of aged persons. MATERIAL AND METHODS One hundred apparently normal aged persons, both males and females, were selected on a random basis. Their basic state of mental and physical health was evaluated on the following parameters: 1. Common complaints, scaled as per Table I. 2. Physiological status regarding body weight, pulse rate, blood pressure, rate of respiration and breath-holding time. 3. Mental status assessed in terms of: i. Level of anxiety measured by Sinha anxiety scale similar to the Hamilton scale but adapted to the Indian environment. ii. Mental fatigue rate determined by previously standardized cancellation sheet. iii. Immediate memory span determined by using random digit chart.
4. Endocrinal and metabolic status determined on following parameters: i. Urinary 17-hydroxycorticosteroids as per method of Appleby et al (1962). ii. Urinary 17-ketosteroids as per method of King (1964). iii. Urinary V.M.A. as per method of Pissano et al (1962). iv. Urinary nitrogen by Nessler's reaction. v. Urinary creatinine as per King's Method (1964). After basal assessments, these persons were prescribed Geriforte with the following dosage schedule, which they continued for 3 months. 1. Two tablets 3 times a day for one month. 2. Two tablets twice a day for subsequent one month. 3. One tablet 3 times a day for third one month. Table I: Subjective scoring sheet Very low 3 General feeling Not completely fit 1 Very low 3 Ability to work Not completely fit 1 Always tired 2 Fatigue Only in the evening 1 Appetite Not satisfactory 1 Normal/Average 0 Digestion Not satisfactory 1 Normal/Average 0 Nil 3 Sex life Improving 1 Sleep Adjustment to Palpitation Chest pain Low backache Insomnia 2 Disturbed 1 Average 1 Always 2 Only on exertion 1 Absent 0 Always 2 Only on exertion 1 Absent 0 Always 3 Often 2 Occasional 1 Nil 0 At the end of every month during the trial, the subjects were reassessed for any change in their complaints, their mental and physical health status as per parameters mentioned above. Finally the effect of the treatment was worked out by comparing the follow-up findings with the respective basal values which were considered as self-controls. RESULTS AND OBSERVATIONS The persons given Geriforte therapy reported a feeling of well-being with an improved health pattern. Significant (p<0.001) subjective improvement was noted in terms of general feeling, ability to work, appetite, digestion, fatigue, sleep, adjustment to temperature variation, chest pain, palpitation etc. (Table II). When evaluated at the end of the third month of the trial, these persons showed a significant gain in body weight (p<0.05). They also showed a significant (p<0.001) increase in breath-holding time and a minor decrease in blood pressure indicating an improvement in their cardiorespiratory functions. In biochemical studies a significant decrease in the rate of urinary nitrogen was noted (Table III). Other biochemical indices did not change significantly.
Table II: Showing the pattern of subjective improvement with Geriforte Sl. Symptoms Before After treatment No. treatment 1 st month 2 nd month 3 rd month 1. General M 2.61 1.7 1.12 0.5 SD 0.627 0.757 0.696 0.659 SE 0.098 0.120 0.177 t 9.67 12.41 11.92 P <0.001 <0.001 <0.001 2. Ability to work M 2.30 1.65 1.13 0.59 SD 0.694 0.708 0.730 0.590 SE 0.101 0.123 0.088 t 6.435 9.512 19.431 3. Appetite M 1.96 1.13 0.94 0.26 SD 0.594 0.826 0.687 0.452 SE 0.142 0.171 0.147 T 5.845 6.549 11.664 4. Digestion M 1.7 0.96 0.71 0.27 SD 0.651 0.325 0.624 0.574 SE 0.109 0.164 0.145 T 0.788 6.036 9.864 5. Fatigue M 2.43 1.79 1.39 0.64 SD 0.5006 0.767 0.882 0.789 SE 0.087 0.118 0.169 t 7.356 8.81 10.591 6. Sleep M 1.82 1.14 0.62 0.53 SD 0.722 0.863 0.730 0.634 SE 0.92 0.152 0.147 t 7.391 7.562 8.775 7. Adjustment to Climate M 1.57 1.23 1.1 0.812 SD 0.690 0.712 0.669 0.615 SE 0.089 0.135 0.135 T 5.487 6.084 7.831 P <0.001 <0.001 <0.001 8. Chest pain M 1.47 0.57 0.307 0.17 SD 0.639 0.646 0.461 0.389 SE 0.164 0.191 0.166 t 5.487 6.084 7.831 9. Palpitation M 1.55 0.88 0.53 0.15 SD 0.889 0.857 0.639 0.375 SE 0.142 0.153 0.180 t 4.718 6.666 7.777 In psychological studies, these persons showed a statistically significant (p<0.001) reduction in the level of anxiety when evaluated after the course of the therapy. They also showed a significant (p<0.05) improvement in their immediate memory span and mental fatigue rate (Table IV).
Table III: Some physiological changes after Geriforte therapy Sl. Before After treatment No. treatment 1 st month 2 nd month 3 rd month 1. Body weight (kg) M 50.58 52.08 52.19 52.47 SD 10.490 10.21 16.48 17.32 SE 0.168 0.292 0.453 t 0.988 0.640 2.490 P >0.05 >0.05 <0.05 2. Pulse/mt M 78.82 80.47 79.43 86.00 SD 12.842 12.102 12.263 20.561 SE 1.200 1.658 2.540 t 0.043 0.944 0.464 3. Respiration/mt M 20.42 22.25 20.84 21.05 SD 6.279 8.281 2.664 3.376 SE 0.432 0.558 0.818 T 1.518 1.505 0.949 4. Breath-holding time in sec. M 29.5 32.75 37.84 40.75 SD 12.859 12.876 12.907 20.717 SE 1.017 3.17 2.433 T 2.14 2.54 2.747 p <0.05 <0.05 <0.05 5. Blood pressure systolic mm Hg M 134.24 129.88 126.95 122.05 SD 36.482 39.394 54.550 18.125 SE 2.181 3.594 4.642 t 1.596 1.536 1.591 p >0.05 >0.06 >0.05 6. Diastolic B.P. mm Hg M 80.20 77.48 78.60 76.88 SD 14.671 24.853 17.514 11.150 SE 2.281 2.674 3.367 t 0.227 0.715 1.357 7. Urinary Nitrogen 21 g creatinine M 7.60 5.90 Table IV: Psychological changes after Geriforte treatment Sl. No. Before treatment After treatment 1. Anxiety Level M 37.07 24.41 SD 19.682 20.304 SE 2.706 t 4.678 p <0.001 2. Immediate memory span M 5.88 6.41 SD 1.363 1.227 SE 0.174 t 3.045 p <0.05 3. Mental Fatigue (Error Score) M 5.666 7.07 SD 5.863 10.35 SE 1.758 t 0.798 p >0.05 4. Mental Fatigue Rate (Work output) M 536.2 678.5 SD 182.49 269.07 SE 44.98 t 3.163 p <0.05
DISCUSSION The observations made in the present studies indicate an overall improvement in the mental and physical health of the aged persons treated with the trial drug, Geriforte. These observations conform with our previous findings (Singh and Sinha, 1978). This drug contains Chyavanprash, a classical Ayurvedic tonic besides a number of other restorative agents and brain tonics like Asvagandha, Brahmi etc. The beneficial effects of Chyavanprash have been worked out earlier by us (Varma et al, 1974). The major component of Chyavanprash is the popular Indian fruit Amalaki (Emblica officinalis Linn.). In our recent studies the drug, Amalaki has been found to show significant beneficial effects on the general health of patients of peptic ulcer, evidenced by gain in body weight, rise in haemoglobin percentage and reduction in urinary nitrogen. Geriforte was also found to decrease the blood level of different neurohumors and the adrenocortical hormones indicating a less stressful status (Varma et al, 1977). Similarly the drugs Brahmi and Asvagandha have been found to possess significant anti-anxiety and adaptogenic activity (Singh, 1977; Singh and Malviya, 1978). The compound Geriforte, which contains Amalaki, Brahmi and Asvagandha, besides several other restorative drugs, appears to produce its general restorative effects by virtue of the Amalaki present in it. Its anti-anxiety activity and other beneficial effects on mental functions may be due to the presence of Medhya Rasayana drugs like Brahmi and Asvagandha. Thus the compound of Geriforte appears to be a rational combination of indigenous drugs for the use of aged persons, as means to prevent the rapid onset of mental and physical disability due to the ageing process. SUMMARY The indigenous compound Rasayana drug, Geriforte was clinically tried in 100 apparently normal aged persons for 3 months. These persons reported a significant improvement in their health. They gained in their health. They gained in their body weight and their cardiorespiratory functions improved. They also showed a significant improvement in their mental functions with reduction in anxiety level and improvement in memory span and mental fatigue rate. Such effects of Geriforte appear to be due to its constituent drugs like Chyavanprash with Amalaki, Brahmi, Asvagandha etc. Thus this compound appears to be a rational combination of indigenous drugs for use in the care of aged persons. REFERENCES 1. Singh, R.H. and Sinha, B.N., Psychobiological studies on the effect of an indigenous compound Rasayana drug in apparently normal aged persons. J. Res. Ind. Med. Yoga and Homoeo. (1978): 13, 1. 2. Varma, M.D., Singh, R.H., Gupta, J. P. and Udupa, K.N., Amalaki Rasayana in the treatment of chronic peptic ulcer. J. Res. Ind. Med. Yoga and Homoeo. (1977): 4, 1. 3. Varma, M.D., Singh, R.H. and Udupa, K.N., Physiological, endocrine and metabolic studies on the effect of Rasayana therapy in aged persons. J. Res. Ind. Med. Yoga and Homoeo. (1973): 2, 1. 4. Singh, R.H. and Malviya, P.C., Studies on the anti-anxiety effect of the Rasayana drug, Asvagandha (Withania somnifera Dunol.), Part I: Clinical Studies. J. Res. Ind. Med. Yoga and Homoeo. (1978): 13, 1. 5. Singh, R.H. and Sinha, B.N., Studies on the effect of an indigenous compound Rasayana drug in cases of Pulmonary Tuberculosis. J. Res. Ind. Med. Yoga and Homoeo. (1979): 1, 21. 6. Singh, Lallan, Studies on the anti-anxiety effect of the Medhya Rasayana drug, Brahmi (Bacopa monniera Linn.). M.D. (Ay.) Thesis (1977), Faculty of Medical Sciences, Banaras Hindu University.