Sarcopenia: Ayurveda Understanding

Sarcopenia is a condition wherein there is quantitative loss of muscles. It is defined as ‘lack of flesh’. It is usually an age-related degeneration which is common in people over 50 years of age.

In this condition there is gradual loss of

–        muscle mass,
–        muscle strength and
–        muscle functioning

As the disease progresses, the person will find it difficult to cope up with everyday activities. He or she shall meet challenges including difficulty in walking, climbing stairs or carrying heavy objects. There will also be a risk of falls and fractures.

In comparison to those having healthy and working muscles in terms of quality and quantity, those having sarcopenia are said to have reduced life expectancy.

Ayurveda Understanding of Sarcopenia

Mamsa Kshaya –

Since there is ‘muscle loss’ in sarcopenia, we can correlate it with ‘mamsa kshaya’ which also means muscle loss.

Sama dhatu i.e. equilibrium of tissues is one of the signs of ‘swastha’ – complete and balanced health. So, in sarcopenia vis-à-vis mamsa kshaya there is loss of muscles and hence is disproportional with other tissues of the body. The decrease can be individual or relative to other tissues.

‘Sama mamsa pramana’ – a state of equilibrium or balance of muscle tissue in terms of its quality and quantity has been mentioned amongst the features of a healthy person. All our activities and movements depend on the health of our muscles.

The symptoms of mamsa kshaya are –

–        aksha glani – tiredness of eyes – probably indicates the weakness of ocular muscles i.e. the muscles in and around the eyes
–        ganda shushkata – dryness and emaciation of muscles around the cheek / facial muscles
–        spik shushkata – dryness and emaciation of muscles of the buttocks
–        sandhi Vedana – pain in the joints of the body (since muscles are the main support for the functioning and movements of the joints)

All these symptoms might reflect the clinical picture of sarcopenia. They indicate all the components, i.e. loss of muscle mass, strength and functioning.

The causes and mechanism may be due to one or more of –

–        Vardhakya – Natural aging – with aging vata increases naturally in the body. This vata is antagonistic to the tissues which are predominantly made up of kapha, muscle being one of them. Increased vata will reduce muscle mass, strength and functioning.
–        Karshya – It is a feature of vata aggravation. Karshya means emaciation or wasting which reflects depletion of tissues, muscle tissue in this context. Karshya while causing destruction of muscles and reduction in their mass can cause sarcopenia.
–        Vatala Ahara Vihara – Foods and activities and practices which increase vata and decrease kapha
–        Pittala Ahara Vihara – Foods and activities which increase pitta
–        Ati vyayama – indulgence in too much exercise, activities and adventures will damage the muscles and bring about reduction in their mass. According to Ayurveda, excessive exercise will cause dhatu kshaya – mainly the pathological decrease of mamsa and meda (fat) tissues. This will increase vata. Subsequently there will be manifestation of sarcopenia and painful symptoms associated with the same.
–        Mandagni, ajirna and ama – Sluggish digestive fire which cannot digest even small and simple forms of food, indigestion and formation and accumulation of excessive ama in the body – all these events lead to inadequate formation of rasa and hence nutritional deprivation of all tissues including muscle tissue. This will lead to sarcopenia.
–        Mamsavaha sroto dushti – Contamination or block of channels transporting the building blocks of the muscles or damage to the same will cause mamsa kshaya. Snayu and Twak are the roots of these channels. Snayu is a term which encompasses many structures which also includes the tendons with the help of which the muscles attach to the bones. When these channels are contaminated, the tendons can become weak, which also indicates that the muscles will become weak and may lose mass later in the process. Injury to the root i.e. tendon can weaken the tree i.e. muscles and lead to loss of mass. This is further substantiated by Master Sushruta wherein he mentions ‘mamsa shosha’ i.e. loss of muscles as one of the symptoms of damage to the mamsavaha srotas and its roots. Collectively we can tell that when the mamsavaha srotas are injured or contaminated, they may lead to loss of muscle tissue, weakening of tendons and hence lead to sarcopenia. Another symptom in this context mentioned by Master Charaka – ‘puti mamsa’ i.e. putrefaction or decaying of muscles indicate contamination, infection or inflammatory process and inflammatory diseases affecting the muscles leading to their suppuration, loss of mass and hence sarcopenia. Raktavahi dhamanis i.e. arteries are also the roots of mamsavaha srotas according to Sushruta. This implies that when blood vessels / arteries supplying the muscles are injured, the muscles will be depleted of nutrients and oxygen. This will lead to loss of muscle mass and subsequent manifestation of sarcopenia.
–        Rasa Kshaya – Raukshya – dryness, shrama – weakness, shosha – loss or depletion or emaciation, glani – fatigue – have been mentioned amongst the symptoms of rasa kshaya i.e. pathological decrease of rasa tissue. Since it is the tissue from which the other tissues are formed, its qualitative and quantitative balance and health will reflect the health of other tissues. Rasa Kshaya symptoms definitely apply to the explanation of loss of muscle tissue and subsequent symptoms and manifestation of sarcopenia in later stage.
–        Rakta Kshaya – Depletion of or pathological decrease of blood tissue may also lead to mamsa kshaya – sarcopenia since muscle is the next tissue formed in the chronology, after blood, as per Ayurveda. This can also be inferred as sarcopenia caused due to decreased blood and nutrition supply to the muscles.
–        Medo Kshaya – Krishangata i.e. emaciation or loss of muscle mass has been mentioned amongst the symptoms of depletion of or pathological decrease of fat tissue.
–        Avyayama – Not exercising the muscles at all will put them in a state of disuse atrophy. The muscles will get weak and may progress towards sarcopenia. Modern medicine also opines that this is a risk factor for sarcopenia.
–        Anashana – Fasting beyond one’s capacity, frequent therapeutic starvation and not getting the nutrition as much as one needs, i.e. malnutrition can cause depletion of muscle tissue leading to sarcopenia.

Other conditions

Many chronic diseases and syndromes may cause loss of muscle mass and become responsible for sarcopenia. Modern medicine too has explained a wide array of diseases which might cause sarcopenia.

a. Rajayakshama

It is a syndrome of many symptoms, each of which is a disease by itself. The causes of Rajayakshma include –

–        Vegarodha – forcibly withholding of natural body urges – which is the main cause of vata aggravation and its abnormal upward movement which can cause wide array of diseases including loss of muscle loss and sarcopenia
–        Kshaya – abnormal deterioration of tissues which causes pathological increase of vata. Kshaya also includes decrease or loss of muscle mass.
–        Sahasa – excessive exercise, as already discussed, causes aggravation of vata which afflicts the muscles to cause sarcopenia
–        Vishamashana – abnormal and erratic food choices which can cause aggravation of vata and tridoshas which further can cause destruction of tissues, including muscles, leading to sarcopenia

The pathogenesis of Rajayakshma explains – The doshas, predominantly kapha, would cause a block of channels of rasa and would cause depletion of the subsequent tissues leading to severe grade of dhatu destruction. The other pathway is – in those who are indulged excessively in sexual activities, there will be severe depletion of semen and retrograde depletion and destruction of all the dhatus. Both these pathways would cause severe grade of dhatu destruction and cause Rajayakshma.

Rajayakshma is a syndrome which encompasses many diseases explained in modern medicine including tuberculosis, AIDS, COPD, Cancer, etc all of which may cause severe grades of tissue destruction leading to conditions like sarcopenia.

Rajayakshma is also compared to another condition called cachexia which means wasting. Modern medicine also opines that cachexia is a risk factor for sarcopenia. Cancer, whose symptoms also resemble rajayakshma, is also a risk factor for sarcopenia and so does HIV and COPD.

b. Shosha

It is a similar condition of the lines of Rajayakshma. It manifests with destruction of tissues and subsequent emaciation and dryness of the body. There are many types of Shosha and all of them can cause sarcopenia. Shosha is caused due to excessive exercise, grief, ageing, sexual indulgence, walking, injuries and wounds and chest injuries. This is also a syndrome and comprises a wide array of diseases which would affect the muscles in the long run.

c. Mamsa Dhatvagni Vriddhi

Excessive increase of mamsa dhatu agni – tissue fire of muscle tissue will lead to muscle burnouts and muscle destruction in the long run which will lead to sarcopenia.

d. Mamsagata Vata – When the aggravated vata gets localized in the muscles, it will start damaging and destroying the muscles. This will lead to many painful conditions of the muscles and conditions like sarcopenia.

e. Vata Vyadhi – In general, any vata vyadhi may accompany and present with muscle loss leading to sarcopenia.

From Causes and Risk factor perspective

Though the natural ageing process is the primary cause of sarcopenia, many other risk factors are said to be contributory. Let us study a few risk factors mentioned in Modern medicine from Ayurveda perspective.

Physical activity – good exercise is good for muscle health. Excessive indulgence in exercise will cause vata aggravation and subsequent loss of tissues due to affliction of aggravated vata. The muscle tissue too gets into the damage line of excessive physical activity and there occurs muscle loss leading to sarcopenia. Alternatively excessive physical activity or exercises can cause damage and destruction (loss) of muscle tissue and other tissues which subsequently causes abnormal increase of vata. This vata further damages the tissues and causes a wide array of disorders including sarcopenia.

Obesity – In a condition named ‘Medoroga’ which describes the diseases caused due to errors of fat metabolism, which includes obesity, it has been said ‘Medasavruta Margatvat Pushyanti Anye Na Dhatavaha’ which means ‘when the channels of the body are occluded by the excessive fat deposits, no other tissue of the body is nourished’. So, the muscle tissue is also nourished in case of obesity and conditions caused due to excessive fat. This may cause sarcopenia.

Chronic Diseases – Due to multiple factors, muscle loss takes place in chronic diseases. These may include decreased digestive power, less production of nutritive juices and less nourishment of tissues including muscle tissue, damage of dhatus – tissues caused by aggravated doshas, blockage of channels of transportation etc.

Malnutrition – Food is the source for maintenance of health of all the tissues, including mamsa – muscles. The ahara rasa – juicy extract of all foods properly digested by the digestive fire in the stomach – circulates throughout the body and nourishes all the tissues, including muscle tissue. When the person does not take food in proper quality and quantity in relation to what is required of the body, the essence of digestion is also formed inadequately. This will not suffice to nourish all the tissues. In the process, there is inadequate nourishment and support to the muscle tissue. This leads to loss of muscle and reduction of muscle bulk. All these events may lead to sarcopenia.

Diabetes Mellitus – Sarcopenia is a complication of Diabetes Mellitus. Pishita or mamsa – muscle tissue is one of the dushyas i.e. contaminant – tissue which is involved in the pathogenesis of prameha vis-à-vis diabetes mellitus. Prameha is also said to be a disease which is predominantly caused by vitiation of medovaha srotas – fat conveying channels. Obesity and errors of fat metabolism are related with diabetes and diabetes with sarcopenia. Modern medicine has considered diabetes mellitus as one of the risk factors in sarcopenia.

Heart failure – Heart failure is said to be one of the risk factors for sarcopenia. Hridaya vis-à-vis heart is the root of rasavaha srotas – channels conveying nutrition and pranavaha srotas – channels conveying oxygen and vital life force to each and every cell, including mamsa i.e. muscles. Hridaya is also a marma – vital organ. Any damage or dysfunction of the heart may deprive nutrition to the muscles and can cause muscle loss and hence lead to manifestation of sarcopenia.

From the symptoms perspective

Most of the symptoms of sarcopenia are due to vata afflicting the muscles and causing their destruction and depletion.

Ayurveda Treatment Principles for Sarcopenia

General Principles of Management

Nidana Parivarjana – Avoidance of causative factors should be insisted upon as the first line of management in sarcopenia. Vata and pitta aggravating foods, activities and behaviours should be avoided. Excessive exercise, sexual indulgence, sedentary life and unplanned starvation or obsessive starvation should be avoided.

Ahara – One should consume proper quality and quantity of foods in accordance with their compatibility, time, season and place of living.

Addressing Ama and Agni – If errors of metabolism and digestion as found with agni variations are evident, they shall be addressed promptly. Treatment for ama should be administered as and when presence of ama and its symptoms are noted. Signs of srotodushti in relation to rasa, rakta, mamsa and medovaha srotas should be noted and if present shall be treated promptly.

Principles of management of Mamsa Kshaya

Below mentioned are the key principles in effectively handling sarcopenia –

i. Combating Vata – Therapies, medicines and foods to balance vata are very much essential in treating sarcopenia. When vata gets balanced, muscle mass, strength and functioning – everything will improve. Care should be taken to diagnose the condition as early as possible and address it. Since this is a disease of old age and old age is predominant with vata and vata activities it is important to address vata aggravation in muscles, when clinical symptoms of the same are found, in the earliest stages of their manifestation. Once the disease is established, and the symptoms are severe and the disease becomes chronic, it is very difficult to cure sarcopenia. Vata diseases become very tough to handle when manifested in old age and is of chronic nature and more so, if it is associated with complications.
ii. Brimhana – The nourishment of muscle tissue is the key principle of treating sarcopenia vis-à-vis mamsa kshaya. Foods, medicines and therapies which are bulk promoting and nourishing shall be administered.
iii. Balya – Medicines, foods and therapies to strengthen the muscles and improve their actions and movements.
iv. Rasayana – Medicines and foods which help in enriching, supporting and strengthening the tissues, works on anti-ageing and rejuvenation principle and are immune modulators shall be administered. They not only boost recovery but also prevent further muscle loss and recurrence of symptoms.

External Therapies

Below mentioned external therapies are extremely helpful in sarcopenia –

–        Abhyanga – herbal oil massage with oils prepared with vata alleviating and muscle nourishing herbs, Ex – Ksheerabala Taila, Ashwagandha Bala Lakshadi Taila, Dhanvantara Taila, Mahamasha Taila, Mahanarayana Taila, Sahachara Taila, Prasarinyadi Taila
–        Dhara – showering in streams of medicated oils over the body, the same oils mentioned in abhyanga shall be used for dhara also
–        Shashtika Shali Pinda Sweda – Bolus sudation prepared with paddy (rice) grown in sixty days processed in medicated decoctions and milk and tied in a bolus.

Panchakarma Therapies

Vasti – medicated herbal enemas – oil and decoction and milk based – to combat vata and strengthen muscles. It is also preventive and causes rejuvenation. Vatahara and Brimhana Vastis should be administered in this direction. Erandamuladi Kashaya Vasti, Dashamula Kashaya Vasti, Dashamula Ksheera Vasti, Raja Yapana Vasti, Mustadi Yapana Vasti are the best choices. For unctuous enema – Ashwagandha Ghritam, Brihat Chagalyadi Ghrita, Ksheerabala Taila, Guggulutiktaka Ghritam, Mahamasha Taila, Sahacharadi Tailam, Bala Tailam, are the best choices.

Virechana – medicated purgation, should be administered to expel morbid pitta and control inflammation.

Other Treatment Principles

Treatments should be given in relation to the below mentioned disorders as and when they are found to be causal for sarcopenia –

–        Karshya
–        Vata Vyadhi
–        Sthoulya and Medo Roga
–        Rajayakshma
–        Shosha
–        Prameha
–        Hrdroga
–        Shwasa
–        Mamsagata Vata
–        Vata Vyadhi
–        Amavata and Sandhigata Vata
–        Mamsa Dhatu Agni Vriddhi

Useful herbs in Sarcopenia

–        Ashwagandha – Withania somnifera
–        Bala – Sida cordifolia
–        Atibala – Abutilon indicum
–        Shallaki – Boswellia serrata
–        Devadaru – Cedrus deodara
–        Punarnava – Boerhavia diffusa,
–        Shatavari – Asparagus racemosus
–        Eranda – Ricinus communis
–        Guduchi – Tinospora cordifolia
–        Rasna – Pluchea lanceolata
–        Dashamula

Useful formulations

–        Maharasnadi Kashayam
–        Sahacharadi Kashayam
–        Prasarinyadi Kashayam
–        Rasonadi Kashayam
–        Balaguluchyadi Kashayam
–        Dashamula Kashayam
–        Drakshadi Kashayam
–        Ashwagandha Churnam
–        Ashwagandha Rasayanam
–        Ajamamsa Rasayanam
–        Ajashwagandha Rasayanam
–        Balarishtam
–        Ashwagandharishtam
–        Dashamularishtam