The effect of SandhaniyaMahakashaya along with diet and exercises in management of JarawashthaAstikshaya and Astibhagna with special reference to Osteoporosis- A Review International of Research in Indian Medicine

-Ayurveda is science of life and longevity with the aim of prevention of the disease, rejuvenation of our body system.


Introduction-
Asthikshya with special reference to Osteoporosis has become growing health problem in elderly population. Jarawastha or Vrudhakalla is Swabhavballapravrutavyadhi by Acharya Sushruta [1] . Acharya Charak said it is svabhavonishpratikriya [2] In this phase of life vata become dominating in all doshas. Vata is responsible for almost all dhatukshaya (depletion of body tissue) including I J -R I M Astikshaya. Vata and Asthi have Ashraya-Aashraayibhava [3] . They are inversely proportional to each other. So Asthi directly affected by vitiation by vatdosha. Astikshaya is explained in 18 types of kshaya by Acharya Charak [4] .

Asthikshaya(Osteoporosis)
is severe common problem. Asthikshaya can be compared to Osteoporosis and it is a rising,global public health problem. In current era lack of awareness of people about diet, exercise elderly people are suffering from osteoporosis which results in increase in bone fragility and fracture susceptibility. It is growing public health problem worldwide. It causes more than 8.9 million fractures annually in elderly people. [5] It affects both genders, however, is more prevalent in woman particularly at menopause. One in three women and one in five men osteoporotic hip fractures in Asia. Bone lose is only partly reversible and treatment available in contemporary science is mainly symptomatic and sometimes surgical intervention require. The treatment in modern medical science includes. [6] 1. Calcium supplement 2. Hormone replacement therapy.

Bisphosphonates
These medicines are not suited for everyone and not devoid of adverse effect. Early intervention can prevent Osteoporosis in majority. So elderly people diet must include milk, ghrita and chicken, mutton stalk.
AcharyaCharaka emphasized that wise person should understand good and bad outcomes of right and wrong eating habits. Acharya mentioned 12 rules of consuming food (Dwadashbhojanvidhi) [17] which must followed elderly people while eating the food to get proper beneficial effect of food.
 Eat warm.  Eat unctuous food  Not to eat too fast.  Not to eat too slow  Do not talk while eating.  Do not laugh while eating  Food intake with self confidence.  Eat in pleasant place with full concentration.( Do not watch television or screen while eating)  Meetaahar: one must fill half your stomach with solid food , a quarter with liquids and keep a quarter empty.Overeating results in partially digested food which in responsible for producing ama'.  Jirnaahar: One must eat after digestion of first meal. Digestive system takes 4 to 5 hours to digest the food.  Sarvarasaabhyasa: Include all six taste in your meal sweet, sour,salty,pungent,bitter and astringent. [18] Similarly, the concept of virudhahara (dietary incompatibility) and its 18 types to be observed in dietary care and people should aware about it.

Lifestyle:
Not only diet can change Asthikshaya pathology, but changes in lifestyle with physicalexercises are necessary to maintain bone mass.

Modern aspect of Drugs
Madhuka [27] (Glycyrrhiza glabra): commonly called as Liquorice / sweet wood is drug with sweet taste .It helps in accelerating wound healing .The potent chemical constituents, such as Glycyrrhizic acid and Glabridia are having anti-oxidant and anti inflammatory properties. The drug provides nourishment to tissues, promote proper blood supply to the ulcer. It helps healing the wound gives stability to newly form tissue. [28] (Tinospora Cordifolia) : A variety of active components derived from the plant like alkaloids , steroids, diterpenoid lactones , aliphatics and glycosides is known for immunomodulating, antineoplastic activities' also has antidiabetic, anti-periodic, antispasmodic, anti-inflammatory, antiarthritic, anti-oxidant, anti-allergic, anti-stress, anti-leprotic, antimalarial, hepatoprotective properties Prishniparni (Urariapicta) [29] : It is perennial herb with distinct leaves . It is important ingredient of 10 herbs of Dashmoola which is known antiinflammatory formulation. The useful partare roots. Roots are having antimicrobial and anti -inflammatory, anti septic properties. Leaves are also having anti-septic properties., used for treatment of wounds. And because of early accumulation of phosphorus and more deposition of calcium, it's very useful for fracture healing.

Madhuparni/Guduchi
Priyangu [30] (Callicarpa Macrophylla): There are 2 varieties Priyangu, Gandhapriyangu. The second one is fragrant one. All parts of plant are used root, bar, leaves flower and fruits. Alcoholicextract of stem showed presence of glycosides, flavinoids, tannins, carbohydrates, steroids and absence of alkaloids,saporine ,proteins and amino acids. While aquousextract shows same constituents. Pharmacological properties are analgesics, digestive, blood purifier. Bark is used in the treatment of rheumatism. The plant has many chemical constituents which are responsible for various pharmacological and medicinal properties.

Discussion:
In this article, Asthikshaya is considered is due to Jarawasthadhatukshaya.
And treatment of Asthikshaya should be done considering vataprakopa. So one must follow the diet,dietary rules, life style and exercises mentioned in this article to prevent the complication(fractures) of Asthikshaya . Also the plants discussed in article are pruthvimahabhuta dominating drugs, having snigdha, deepanguna. Though they are having tikta, katu, kashayarasathat may aggravate vata, they can be administer with ghrita or kshira . These plant siddhaghrita or kshira provide nourishment to Asthi.

Conclusion:
Asthikshaya (Osteoporosis) is most common metabolic bone disorder characterised by reduced bone mass and osteoporotic fracture. This condition seriously affects the quality of life of individual and needs an effective treatment without adverse effect.
So diet, lifestyle with