HEART FAILURE
Definition
Heart failure, also known as congestive heart failure (CHF), means your heart can't pump enough blood to meet your body's needs. Over time, conditions such as coronary artery disease or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.
You can't reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure and lead to improved survival. Lifestyle changes, such as exercising, reducing salt intake, managing stress, treating depression, and especially losing excess weight, also can help prevent fluid buildup and improve your quality of life.
The best way to prevent heart failure is to control risk factors and aggressively manage any underlying conditions such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity.
Symptoms
Heart failure typically develops slowly and is a chronic, long-term condition, although you may experience a sudden onset of symptoms, known as acute heart failure. The term "congestive heart failure" comes from blood backing up into — or congesting — the liver, abdomen, lower extremities and lungs.
Some of the signs and symptoms for chronic and acute heart failure are
Type of heart failure Signs and symptoms
Chronic heart failure
(A long-term condition with signs and symptoms that persist.) Fatigue and weakness
Rapid or irregular heartbeat
Shortness of breath (dyspnea) when you exert yourself or when you lie down
Reduced ability to exercise
Persistent cough or wheezing with white or pink blood-tinged phlegm
Swelling (edema) in your legs, ankles and feet
Swelling of your abdomen (ascites)
Sudden weight gain from fluid retention
Lack of appetite and nausea
Difficulty concentrating or decreased alertness
Acute heart failure
(An emergency situation that occurs when something suddenly affects your heart's ability to function.) Signs and symptoms similar to those of chronic heart failure but more severe, and start or worsen suddenly
Sudden fluid buildup
Rapid or irregular heartbeat with palpitations that may cause the heart to stop beating
Sudden, severe shortness of breath and coughing up pink, foamy mucus
Chest pain if caused by a heart attack
In addition to characterizing whether your condition is chronic or acute, your doctor will need to know whether your heart fails to pump, or fills with blood, or a combination of both. Heart failure can involve the left side, right side or both sides of your heart. Typically, heart failure begins with the left side — specifically the left ventricle, your heart's main pumping chamber.
Part of your heart affected by heart failure Description
Left-sided heart failure Most common form of heart failure.
Fluid and blood may back up in your lungs, causing shortness of breath.
Right-sided heart failure Often occurs with left-sided heart failure.
Fluid and blood may back up into your abdomen, legs and feet, causing swelling.
Systolic heart failure The left ventricle can't contract vigorously, indicating a pumping problem.
Diastolic heart failure
(also called heart failure with normal ejection fraction) The left ventricle can't relax or fill fully, indicating a filling problem.
While systolic heart failure was once thought to be more common and less serious, recent studies have shown this to be incorrect. Isolated diastolic heart failure, now also termed "heart failure with normal ejection fraction," is just as common as systolic heart failure and has a similar prognosis. Identifying the type of heart failure, whether systolic, diastolic, or a combination, is important because the drug treatments for each type may
Causes
Heart failure often develops after other conditions have damaged or weakened your heart. Over time, the heart can no longer keep up with the normal demands placed on it. The ventricles may become stiff and not fill properly between beats. Also, the heart muscle may weaken, and the ventricles stretch (dilate) to the point that the heart can't pump blood efficiently throughout your body.
Any of the following conditions can cause heart failure, which can damage or weaken your heart over time. Some of these can be present without knowing it:
Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits, a process called atherosclerosis. Blood moves slowly through narrowed arteries, leaving some areas of your heart muscle weak and chronically deprived of oxygen-rich blood. In many cases, the blood flow to the muscle is just enough to keep the muscle alive but not functioning well. A heart attack occurs if plaque formed by the fatty deposits in your arteries ruptures. This causes a blood clot to completely block blood flow to an area of the heart muscle, weakening the heart's pumping ability.
High blood pressure (hypertension) . Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform, enlarging the heart. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
Faulty heart valves. The four valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve forces your heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken your heart. Faulty heart valves, however, can be fixed if detected in time.
Damage to the heart muscle (cardiomyopathy) . Some of the many causes of heart muscle damage, also called cardiomyopathy, include infections, alcohol abuse, and the toxic effect of drugs such as cocaine or some drugs used for chemotherapy. In addition, whole-body diseases, such as lupus, or thyroid problems also can damage heart muscle. If a specific cause can't be found, it's referred to as idiopathic dilated cardiomyopathy.
Myocarditis. Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure.
Heart defects present at birth (congenital heart defects). If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to compensate. Genetic defects contribute to the risk of certain types of heart disease, which in turn may lead to heart failure.
Abnormal heart rhythms (heart arrhythmias) . Abnormal heart rhythms may cause your heart to beat too fast. This creates extra work for your heart. Over time, your heart may weaken leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
Other diseases. Chronic diseases such as diabetes, severe anemia, hyperthyroidism, hypothyroidism, emphysema, lupus, hemochromatosis and amyloidosis also may contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.
Risk factors
A single risk factor may be enough to cause heart failure, but a combination of factors increases your risk.
Risk factors include:
High blood pressure. Your heart works harder than it has to if your blood pressure is high.
Coronary artery disease. Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakened heart muscle.
Heart attack. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.
Irregular heartbeats. These abnormal rhythms can create extra work for your heart, weakening the heart muscle.
Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.
Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure. Don't stop taking these medications on your own, though. If you're taking them, discuss with your doctor whether you need to make any changes.
Sleep apnea. The inability to breathe properly at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart.
Congenital heart defects. Some people who develop heart failure were born with structural heart defects.
Viruses. A viral infection may have damaged your heart muscle.
Alcohol use. Alcohol can weaken heart muscle and lead to heart failure.
Kidney conditions. These can contribute to heart failure because many can lead to high blood pressure and fluid retention.
When to seek medical advice
See your doctor if you experience any of the signs or symptoms associated with heart failure. These include:
Fatigue and weakness
Rapid or irregular heartbeat
Shortness of breath (dyspnea) when you exert yourself or when you lie down
Reduced ability to exercise
Persistent cough or wheezing with white or pink blood-tinged phlegm
Swelling in your abdomen, legs, ankles and feet
Difficulty concentrating or decreased alertness
You may first find out you have heart failure from an emergency room visit after worsening signs and symptoms. Other heart and lung problems can cause signs and symptoms that are similar to heart failure.
If you have a diagnosis of heart failure, and if any of the signs or symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. Contact your doctor promptly.
Compiled By
Dr Sandeep KM Delhi
Sunday, August 24, 2008
Heart Failure
Friday, August 1, 2008
panchakarma
Panchakarma
A healthy body and healthy mind is the aim of all medical systems. Ayurveda is one such system that prevailed since 5,000 years ago. It was considered the most advanced and scientifically proven in those days. It still continues to shine. The present millennium has shown us numerous disorders and we know that the changes in atmosphere and living conditions are among the causes. This results in serious disorders like cancer and AIDS. To handle these problems, Ayurveda shows the correct way. The word Ayurveda is composed of Ayu and Veda. Ayu means life, which is a proper combination of the body, mind, sense organs and the soul. Veda means knowledge.
Pizhichil, one of the purvakarmas.
The Vedas revealed the truth that all the living and non-living things are a combination of pancha bhoota (prithvi, ap, thejas, vayu, akasa). Ayurveda also agrees with this principle. To regulate the living body easily, the acharyas concised the pancha bhootas into tridoshas (vata, pitta, kapha). These tridoshas are the basic pavement for all ayurvedic theories. Along with tridoshas, datusamjna, malasamjna are given to certain constituents for the functioning concept of living things. Datus and malas are controlled by doshas. Samyavastha (well-being) is the condition when the doshas are in their natural rhythm. When this rhythm is lost it is called vaishamya (disease). The former means order, the latter, disorder.
Doshas cannot be identified separately in samyavastha. In diseased condition, the doshas manifest their particular symptoms. These symptoms denote malfunctioning of the doshas. The purpose of treatment of all diseases is to keep the doshas in equilibrium. In Ayurveda there are three steps in treating any diseases, they are samsodhana - cleansing process, samsamana - palliative measures and nidanaparivarjana - treating the causes.
Samsodhanam is considered a prominent process and should be administered with full care. Samsodhana is so important because the diseases treated by samsamana may occur again but those treated by the former will never recur or the chances of recurrance are very small.
Panchakarma is a synonym for samsodhana. Panchakarma actually is a group of treatments, five in number, all of which are not commonly practised in all diseases. The panchakarma are vamana, virechana, snehavasti, kashayavasti and nasya. Vamana is emesis, virechana is purging, vasti is enema, which of two kinds done with medicated oils and medicated decoctions and are called snehavasti and kashayavasti respectively. Nasya is instillation of medicines through nose. Susrutha, the father of surgery, gives stress to rakthamoksha (blood-letting) as one of the panchakarma, taking the two kinds of vasti as a single karma.
There are certain steps to be followed before doing panchakarma called poorvakarmas. They are snehana (oleation) and swedana (sudation). Snehana has to be done by two ways, application of snehadravyas internally and externally. Swedana is classified into four types to promote sweat. The purpose of poorvakarma is to liquefy and guide the provoked doshas to the mainstream to facilitate the sodhana karma.
The process of letting out the vitiated blood is termed Rakthamoksha.This is an illustration of Lord Dhanwanthri holding a leech in the right hand whichis extensively used in blood letting.
Vamana (Emesis)
The first in panchasodhana karma, this process requires good attention and skilled assistance. It induces expulsion of the stomach contents through the mouth. Kapha or kapha dominant diseases are selected for this procedure. Diseases like severe skin diseases (psoriasis, urticaria) bronchial asthma, mental disorders and so on. This process is not suggested for pregnant women, the aged, those suffering from cardiac problems and those who are not very strong. On the previous day, the patient, who has undergone sneha sweda is given kapha increasing foods. The next morning, after ablutions and a hot water bath, the patient should be asked to sit in a relaxed manner in an armchair. Milk is commonly used for this purpose. For those with milk intolerance, sugarcane juice can be used. The patient has to drink as much as milk as he can. Then a paste of madana phala (10 gms) along with yashtimadhu powder (5 gms), vacha (5 gms), rock salt (5 gms) and honey (5 ml) mixed with milk should be given. Within a short time, the patient will feel nauseous and starts vomiting. All impure accumulated kapha will come out. Normally eight bouts are seen. The attenders should hold the patient's forehead and massage his back and wipe away the sweat. Vomiting is stopped when the pitta or yellow colouration is seen, which is considered the correct symptom. If the bouts are less, vomiting should be by irritating the uvula by touching with the figers or a quill. Then allow the patient to wash his face and fingers with hot water. Then dhoomapana - inhalation of medicated fumes - is done. The smoke should be inhaled through one nostil and exhaled through the mouth and the other nostril. This should be done thrice.
Closer view of the image of Lord Dhanwantri depicting the leech.
After this, certain steps have to be necessarily followed called paschat-karma. These are mainly food restrictions, called samsarjana kriya. Just after vamana, if the patient is hungry, thin gruel is given. After ascertaining the digestive power, thick gruel, porridge, porridge with meat soup are given. The entire treatment takes 15 days.
Virechana (Purgation)
Pitta and pitta dominant diseases are cured by this process. By this the vitiated doshas are made to pass through the anus. Poorvakarma as noted in vamana are advocated here. Though several drugs are mentioned for virechana, trivrit is considered the best. Trivrit combinations, like avipathy churna, trivrileha are used. To give the medicine it should be ascertained whether the last meal has been digested. Medicine should be given after the kaphakala (about 9 a.m.) - 15 to 25 gms of Avipathy churna mixed with hot water. No food is given till virechana is over. In proper virechana, the patient passes urine, stool, pitta, medicine, kapha and vata in order. About 20 purges may be seen. This also depends on the patient's health.
A mild form of virechana is an unavoidable factor in ayurvedic therapy. It is commonly used to treat various kinds of ailments in which poorvakarma is not necessary. So virechana is also used for prevention. The paschat karma followed is similar to that of vamana except that dhoomapana is not administered.
Vasti (Enema)
This is a process of injecting fluid through the anal, urinary or vaginal canal. Vasti or the urinary bladder of animals is used and hence this term. Today, a bag of polyethene or leather is used. Vasti is for combating vata and vata dominant diseases. As vasti is important among the panchakarma, many consider vasti as half the entire range of treatment and some as the complete range. The equipment for vasti karma consists of a nozzle and a bag.
Nasya as a method of medicinal application was extant for a long period. The Valmiki Ramayana contains descriptions of Rama and other warriors who were restored to consciousness by using medicinal herbs as nasya. The famous physician Jivaka was said to have treated Lord Buddha by Nasya.
Snehavasti is Vasti with unctuous oils. This is not advised in patients suffering from diabetes, anaemia, diarrohea, obesity, filaria. After poorvakarma, the patient is advised to take a hot water bath and permitted to eat a light meal not more than three quarters of usual quantity, a suitable drink may follow. He should lie down in a cot on his left side (left lateral position) (i.e.: the left is stretched and right one is folded). The suitable oil is poured in the vasti bag which is connected with the nozzle. The nozzle end and anus are soothened with oil and enema is applied. Gentle pressure should be applied on the bag so that the fluid passes without interruption. The patient should now lie on his back. Certain methods are adopted to retain the oil inside the body such as raising the leg. The effectiveness of the vasti is indicated if the oil stays inside for the intended period and comes out with all faeces and air.
The quantity of oils is one quarter of kashaya vasti (10 ozs) mixed thoroughly with powdered rock salt, satahva (5 gm each), and warmed suitably before giving.
Kashaya vasti
Diseases like hemiplegia, IVDP, and disease due to vata are treated as well. Acute diarrhoea, chest lesions, piles, hiccups, are contraindicated. For kashaya vasti, honey, rock salt, sneham, paste of medicines are required and is mixed one by one in the above order. Total quantity is nearly 40 ozs. An emulsion is made by churning all and warming in a water bath. This should be taken on an empty stomach at about 10 a.m. Application is the same as snehavasti. When the bowels are clear the patient is allowed to take a hot water bath. This should be done after two or three snehavastis. Sneham, paste of medicines, kashayam noted above are selected as per disease and stage.
Nasya
Instillation through the nose is called nasya. It is the best and important procedure for the treatment of sirorogas i.e, sodhana of urdhvanga. Our body is compared to a tree, its root is the head and extremities are the branches. Head is also called uttamanga, as it is the seat of manas and panchendriyas, which gives a unique status of superiority. This is contraindicated in various manorogas, asthma, cough.
After suitably warmed oil is applied to the shoulder and neck of the patient, the patient should lie supine and tip his head back. Lightly warmed oil is dropped into each nostril. The patient should inhale deeply. The usual dose is 8 drops but this varies according to the disease and its nature. The timings are morning in kapha diseases, noon in pitta diseases and evening in vata diseases. After the nasya, the shoulder, face, palm and sole of limbs should be massaged briskly for few minutes. The percolated kapha will be spat. Dhoomapana and gargling with hotwater should be done afterwards. Nasya should not be done continuously for more than seven days.
Panchakarma should not be administered to those below seven years and those above 80 years. If it is done properly, healing of the disease treated, along with clear intelligence, alertness of the senses, stability of the body, efficacy of digestion and absorption, prolongation of youth are all achieved.
Pizhichil, one of the purvakarmas.
The Vedas revealed the truth that all the living and non-living things are a combination of pancha bhoota (prithvi, ap, thejas, vayu, akasa). Ayurveda also agrees with this principle. To regulate the living body easily, the acharyas concised the pancha bhootas into tridoshas (vata, pitta, kapha). These tridoshas are the basic pavement for all ayurvedic theories. Along with tridoshas, datusamjna, malasamjna are given to certain constituents for the functioning concept of living things. Datus and malas are controlled by doshas. Samyavastha (well-being) is the condition when the doshas are in their natural rhythm. When this rhythm is lost it is called vaishamya (disease). The former means order, the latter, disorder.
Doshas cannot be identified separately in samyavastha. In diseased condition, the doshas manifest their particular symptoms. These symptoms denote malfunctioning of the doshas. The purpose of treatment of all diseases is to keep the doshas in equilibrium. In Ayurveda there are three steps in treating any diseases, they are samsodhana - cleansing process, samsamana - palliative measures and nidanaparivarjana - treating the causes.
Samsodhanam is considered a prominent process and should be administered with full care. Samsodhana is so important because the diseases treated by samsamana may occur again but those treated by the former will never recur or the chances of recurrance are very small.
Panchakarma is a synonym for samsodhana. Panchakarma actually is a group of treatments, five in number, all of which are not commonly practised in all diseases. The panchakarma are vamana, virechana, snehavasti, kashayavasti and nasya. Vamana is emesis, virechana is purging, vasti is enema, which of two kinds done with medicated oils and medicated decoctions and are called snehavasti and kashayavasti respectively. Nasya is instillation of medicines through nose. Susrutha, the father of surgery, gives stress to rakthamoksha (blood-letting) as one of the panchakarma, taking the two kinds of vasti as a single karma.
There are certain steps to be followed before doing panchakarma called poorvakarmas. They are snehana (oleation) and swedana (sudation). Snehana has to be done by two ways, application of snehadravyas internally and externally. Swedana is classified into four types to promote sweat. The purpose of poorvakarma is to liquefy and guide the provoked doshas to the mainstream to facilitate the sodhana karma.
The process of letting out the vitiated blood is termed Rakthamoksha.This is an illustration of Lord Dhanwanthri holding a leech in the right hand whichis extensively used in blood letting.
Vamana (Emesis)
The first in panchasodhana karma, this process requires good attention and skilled assistance. It induces expulsion of the stomach contents through the mouth. Kapha or kapha dominant diseases are selected for this procedure. Diseases like severe skin diseases (psoriasis, urticaria) bronchial asthma, mental disorders and so on. This process is not suggested for pregnant women, the aged, those suffering from cardiac problems and those who are not very strong. On the previous day, the patient, who has undergone sneha sweda is given kapha increasing foods. The next morning, after ablutions and a hot water bath, the patient should be asked to sit in a relaxed manner in an armchair. Milk is commonly used for this purpose. For those with milk intolerance, sugarcane juice can be used. The patient has to drink as much as milk as he can. Then a paste of madana phala (10 gms) along with yashtimadhu powder (5 gms), vacha (5 gms), rock salt (5 gms) and honey (5 ml) mixed with milk should be given. Within a short time, the patient will feel nauseous and starts vomiting. All impure accumulated kapha will come out. Normally eight bouts are seen. The attenders should hold the patient's forehead and massage his back and wipe away the sweat. Vomiting is stopped when the pitta or yellow colouration is seen, which is considered the correct symptom. If the bouts are less, vomiting should be by irritating the uvula by touching with the figers or a quill. Then allow the patient to wash his face and fingers with hot water. Then dhoomapana - inhalation of medicated fumes - is done. The smoke should be inhaled through one nostil and exhaled through the mouth and the other nostril. This should be done thrice.
Closer view of the image of Lord Dhanwantri depicting the leech.
After this, certain steps have to be necessarily followed called paschat-karma. These are mainly food restrictions, called samsarjana kriya. Just after vamana, if the patient is hungry, thin gruel is given. After ascertaining the digestive power, thick gruel, porridge, porridge with meat soup are given. The entire treatment takes 15 days.
Virechana (Purgation)
Pitta and pitta dominant diseases are cured by this process. By this the vitiated doshas are made to pass through the anus. Poorvakarma as noted in vamana are advocated here. Though several drugs are mentioned for virechana, trivrit is considered the best. Trivrit combinations, like avipathy churna, trivrileha are used. To give the medicine it should be ascertained whether the last meal has been digested. Medicine should be given after the kaphakala (about 9 a.m.) - 15 to 25 gms of Avipathy churna mixed with hot water. No food is given till virechana is over. In proper virechana, the patient passes urine, stool, pitta, medicine, kapha and vata in order. About 20 purges may be seen. This also depends on the patient's health.
A mild form of virechana is an unavoidable factor in ayurvedic therapy. It is commonly used to treat various kinds of ailments in which poorvakarma is not necessary. So virechana is also used for prevention. The paschat karma followed is similar to that of vamana except that dhoomapana is not administered.
Vasti (Enema)
This is a process of injecting fluid through the anal, urinary or vaginal canal. Vasti or the urinary bladder of animals is used and hence this term. Today, a bag of polyethene or leather is used. Vasti is for combating vata and vata dominant diseases. As vasti is important among the panchakarma, many consider vasti as half the entire range of treatment and some as the complete range. The equipment for vasti karma consists of a nozzle and a bag.
Nasya as a method of medicinal application was extant for a long period. The Valmiki Ramayana contains descriptions of Rama and other warriors who were restored to consciousness by using medicinal herbs as nasya. The famous physician Jivaka was said to have treated Lord Buddha by Nasya.
Snehavasti is Vasti with unctuous oils. This is not advised in patients suffering from diabetes, anaemia, diarrohea, obesity, filaria. After poorvakarma, the patient is advised to take a hot water bath and permitted to eat a light meal not more than three quarters of usual quantity, a suitable drink may follow. He should lie down in a cot on his left side (left lateral position) (i.e.: the left is stretched and right one is folded). The suitable oil is poured in the vasti bag which is connected with the nozzle. The nozzle end and anus are soothened with oil and enema is applied. Gentle pressure should be applied on the bag so that the fluid passes without interruption. The patient should now lie on his back. Certain methods are adopted to retain the oil inside the body such as raising the leg. The effectiveness of the vasti is indicated if the oil stays inside for the intended period and comes out with all faeces and air.
The quantity of oils is one quarter of kashaya vasti (10 ozs) mixed thoroughly with powdered rock salt, satahva (5 gm each), and warmed suitably before giving.
Kashaya vasti
Diseases like hemiplegia, IVDP, and disease due to vata are treated as well. Acute diarrhoea, chest lesions, piles, hiccups, are contraindicated. For kashaya vasti, honey, rock salt, sneham, paste of medicines are required and is mixed one by one in the above order. Total quantity is nearly 40 ozs. An emulsion is made by churning all and warming in a water bath. This should be taken on an empty stomach at about 10 a.m. Application is the same as snehavasti. When the bowels are clear the patient is allowed to take a hot water bath. This should be done after two or three snehavastis. Sneham, paste of medicines, kashayam noted above are selected as per disease and stage.
Nasya
Instillation through the nose is called nasya. It is the best and important procedure for the treatment of sirorogas i.e, sodhana of urdhvanga. Our body is compared to a tree, its root is the head and extremities are the branches. Head is also called uttamanga, as it is the seat of manas and panchendriyas, which gives a unique status of superiority. This is contraindicated in various manorogas, asthma, cough.
After suitably warmed oil is applied to the shoulder and neck of the patient, the patient should lie supine and tip his head back. Lightly warmed oil is dropped into each nostril. The patient should inhale deeply. The usual dose is 8 drops but this varies according to the disease and its nature. The timings are morning in kapha diseases, noon in pitta diseases and evening in vata diseases. After the nasya, the shoulder, face, palm and sole of limbs should be massaged briskly for few minutes. The percolated kapha will be spat. Dhoomapana and gargling with hotwater should be done afterwards. Nasya should not be done continuously for more than seven days.
Panchakarma should not be administered to those below seven years and those above 80 years. If it is done properly, healing of the disease treated, along with clear intelligence, alertness of the senses, stability of the body, efficacy of digestion and absorption, prolongation of youth are all achieved.
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