Academician Han Qide: What is aging?

It is often said that "love is an eternal theme", but in fact, death is an "eternal theme". The reason why it is "eternal" is because of its "no solution", and no one will really have the experience of "death". The second is because it is important, in the words of Professor Wang Fang, if we do not solve the understanding of death, people will always live in the fear of death, and when they die, they will be extremely painful.

At the societal level, the fear of death is also an important source of excessive medical treatment and over-rescue at the end of life.

The understanding of death, which I elaborated on in an article three years ago titled "Feeling Death," has been subsumed in my little book, The Temperature of Medicine. Today I would like to focus on another issue that is closely related to death: aging.

Like death, aging is an inevitability, and it is a long slope of life. In addition to people who die early due to various reasons, the average person will die through aging. Aging is a prelude to death.

Part.1

What is aging?

The World Health Organization defines it as follows: "Aging is a process in which various molecular and cellular damage in the body accumulates over time." The famous medical humanities writer Gerwende showed through vivid cases: "Aging is a series of continuous loss of function". Thomas Jefferson of the United States wrote vividly to the 78-year-old John Adams at the age of 71: "Our machine has been running for seventy or eighty years, and it can be expected that it will be damaged, here a wheel, there is a wheel, now a gear, the next time a spring, will fail, although we can temporarily repair it, but it will eventually stop functioning." ”

Aging is both an independent state and interdependent with disease

Figuratively speaking, aging and disease are cars running on two tracks, but they may change tracks and merge tracks at any time. On the one hand, aging is a hotbed of disease, which will form and accelerate certain diseases; on the other hand, diseases may boost the process and extent of aging. But whether there is a disease or not, at a certain age, the body will be in a continuous aging process without exception, aging accumulates to a certain extent, usually slide into the situation of "no disease and end", of course, do not rule out that the disease acts as a "trigger" in it, triggering the "domino" effect, the medical term is from multi-organ weakness to multiple organ failure.

Between aging and death, there is a period called deep aging, which is called the end of life in medicine, that is, the stage of hospice care, which used to be called "hospice care", and in April 2016, the BIJ bi-weekly meeting of the Chinese People's Political Consultative Conference proposed to change it to "hospice care". Hospice care is very important and concerns the quality of everyone's life.

Aging is a process that occurs one after another throughout the body, and it only happens sooner or later between people, and the order is different

The most common and prominent manifestation of aging is the narrowing of blood vessels throughout the body, insufficient blood supply to organs, which brings about a decrease in the function of various organs and even weakness, and the severe atherosclerotic lesions of the central cerebral blood vessels lead to myocardial infarction and stroke.

Immune function generally declines during aging, anti-infection ability is low, and the invasion of a small number of pathogenic microorganisms can easily lead to serious infection, which is manifested in many organs, especially the lungs.

Aging occurs when the level of various hormones decreases, resulting in muscle atrophy and weakness, osteoporosis, easy falls and fractures.

During aging, the number of brain cells and interconnections decrease, memory declines, and in severe cases, mental disorders such as dementia occur, and dementia and amnesia occur one after another.

During aging, the chance of gene replication, transcription, and translation errors increases, the accumulation of errors superimposed, and the weakening of error correction ability caused by the decline in immunity, the incidence of cancer will be greatly increased, and so on.

All of this is not only manifested by a decline in various physiological functions, but also often leads to a wide variety of diseases. It can be said that aging provides a broad background for disease.

Aging not only increases the occurrence of diseases, but also significantly changes the nature and pathological process of the disease

For the same disease, the clinical manifestations, treatment responses, and outcomes of the elderly will be very different from those of non-elderly people, such as the elderly may not have a fever even if they are seriously infected, and the number of white blood cells is not obvious; for example, the tolerance to surgical blows and drug side effects is significantly reduced.

Therefore, the diagnosis and treatment of diseases in the elderly should also be different from those of general adults. We do not pay enough attention to this clinically, often affecting the quality of medical treatment and even forming accidents.

Aging is a comprehensive process, multiple organ functions are lost one after another, and the elderly often have a variety of diseases at the same time

Therefore, to treat elderly patients, we must pay more attention to systematic analysis, distinguish priorities and priorities, and resolve major contradictions. If you diagnose and treat one disease by one, if you grasp the eyebrows and beards, you will inevitably lose sight of one or the other, and even conflict with each other, bringing serious consequences.

We now see many elderly people taking 7-8 or even more than a dozen drugs a day, which is the result of diagnosis and treatment according to the division, and each doctor only cares about the patients of a certain system and a certain organ, and lacks coordination.

All drugs are toxic side effects, these toxic side effects also have a superimposed effect, even if the toxic side effects are not obvious, various drug effects may also conflict with each other. Therefore, taking multiple drugs at the same time is often harmful to the body. Therefore, geriatric experts have reached a consensus that the elderly should not take more than 5 drugs at the same time every day.

Since multiple organs are lost during aging, most of which cannot return to normal, we must learn to "coexist peacefully" with them.

For example, studies have shown that as men age, the likelihood of cancer lesions in the prostate gland increases, and in other autopsies of the cause of death, the detection rate of prostate cancer foci in people over 70 years old is as high as 82%. The presence of cervical cancer, breast cancer and other lesions in the elderly in female autopsies also accounts for a considerable proportion. For such cancer foci, compared with other lesions in the elderly body, it is really not a big problem, and it is completely possible to "coexist peacefully". On the other hand, if we continue to increase the intensity of screening and take "encirclement and suppression" treatment for such lesions, it will bring huge damage to the body and spirit.

The constant loss of the functions of various organs in the whole body during aging will inevitably bring about diseases, either here or there; in the end, it is not this serious disease or that serious disease, which leads to our death. In fact, what causes us to die is not a specific disease, the real cause of death is aging, it is because we have exhausted and are doomed to collapse. It's just that we are now accustomed to artificially identifying a disease as a cause of death, and denying "death in old age" and "old age".

Part.2

How to delay aging?

For aging, we are not completely inactive, we can prevent premature aging caused by unhealthy lifestyles, and even delay the aging process to a certain extent. For example, smoking, alcoholism, eating and drinking, sedentary, etc. will definitely accelerate aging, and if we change these bad habits, we can relatively delay aging.

We can also actively explore some healthy lifestyles. In this regard, there are already many introductions, just a little personal experience. 20 years ago, my lumbar spine has developed degenerative lesions, and then sexual development, 8 years ago there were serious symptoms, although the symptoms were alleviated by conservative treatment, but low back pain has become the norm of life; I think that "eating iron can do" The digestion and absorption capacity has decreased significantly, the body is getting thinner and thinner, and the arms and legs are getting thinner and thinner The visual acuity that has been proud has gradually decreased from 1.5 to 0.7, and there are cataracts; the physical examination summary report lists more than 20 abnormalities, including 4-5 suspicious shadows in imaging (of which prostate cancer is highly suspected), a number of tumor marker indicators are elevated, and immune cell function is abnormal.

The obvious acceleration of the aging process prompted me to start fitness training from three years ago, 2-3 times a week, I was happy to see that my body had improved rapidly, the muscles were developed, the whole person stood up, all aspects of the function were improved, friends praised me for "not seeing old", I myself felt as if the pace of aging had slowed down. When I was young, I read Jin Yong's martial arts novels, and often lamented that those crane-haired and childlike martial arts elders in the books were not only athletic, fast and strong, but also waist and abdomen flowed freely, presumably not a secret book to study, the elixir carried with me, but in the cold and summer exercises, after years of perseverance.

Part.3

The spiritual implications of aging also need to be explored in depth

The above is all about aging at the physiological level, but I think that the spiritual meaning of aging also needs to be deeply explored, and spirit and physiology are closely related.

In the face of the same aging situation, in the face of the loss of physiological functions one by one, in the face of more and more chronic diseases that accompany aging, different people will have different attitudes. Some people accept it calmly, calmly cope with it, maintain their love for life and the excitement of life, just like the silver-haired people of the Tsinghua Shanghai Alumni Association Choir, who are full of pride, "returning is still a teenager"; others are in a panic about their bodies and diseases all day long, and they are frustrated, disordered, and lost in the ups and downs of life.

Different attitudes depend on an understanding of life, life, and death, as well as the corresponding mental state; and thus affect the quality of life in later life, and even the process of aging.

Aging is accompanied by the loss of a range of physiological functions and the pain of disease. However, from the spiritual level, life has gone through all stages of childhood, adolescence, youth and middle age, seen the world, experienced, the mind and thought are more mature, more able to understand the true meaning of life and life, if cultivated well, can be as calm as water, honor and disgrace, transcend all kinds of frustrations and losses in life, look at the world, and be willing to eat the situation, such a realm is impossible for ordinary young people to reach.

In this regard, there are very unique insights and expressions in the Chinese cultural tradition. The poem by the Tang Dynasty poet Liu Yuxi most vividly expounds this truth, and the first half of the poem expresses the physical state of aging: "Whoever cares about old age has pity." Fatigue band frequency reduction, thin crown self-bias. Scrap books for the eyes, more moxibustion for the years. But in the second half of the poem, his true spiritual world is revealed: "The scriptures are still familiar with things, and reading people is like reading rivers." After careful consideration, it is fortunate to be here. Mordaunt Sang Yu evening, for Xia still full of heaven. "Yes, the sunset is shining at night, the red glow is full of sky, only this green, the past has been through the past, the old people pity, let go of everything, welcome the new life, what a beautiful scene!

Right now, we live in the torrent of the information age. All kinds of information about life knowledge and attitudes to life are pouring in, all the time all around us. If we take the perception and discussion of aging, the eternal topic of mankind, as the topic, how should we grasp it? Which is "old" and which is "new"? Modern life knowledge is certainly new, but is the ancient and vital spiritual realm, or life attitude, constantly prompting us and caring for us at the level of human wisdom?

Dear elderly friends, let us age and live happily!

Author: Han Qide

(Pathophysiologist, academician of the Chinese Academy of Sciences,

Honorary Chairman of China Association for Science and Technology)

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