Ayurveda is originated from the Atharvaveda and was preached by Lord Brahma. Its Prayojana is to maintain the health of healthy and to cure the diseases of diseased. In Ayurveda, Sthaulya has been described in all the literatures. Acharya Charaka has described Sthaulya Purusha mong one of the Ashta Nindita Purusha. Sthaulya is caused due to Medovriddhi which includes abnormal and excessive accumulation of Medodhatu in the body. This is caused by frequent and excessive intake of Madhur and Snigdhaahara, lack of physical and mental exercises. These all results into the increase in Kapha Dosha and Medo Dhatu results in the Sthaulya. In modern science, Sthaulya can be compared to the obesity. Obesity is one of the metabolic disorder. WHO considers obesity as a Global epidemic and a public health problem. It is estimated that more than 300 million adults are obese and many are overweight. Sthaulya (obesity) is discouraged by the society for social as well as on the medical grounds. Three main causes have been described in modern literature viz. Dietetic, Genetic and Hormonal. Person of every age and sex is suffering by this widely spreaded epidemic i.e. obesity. It is the major chronic disease in developing as well as in developed countries. The line of treatment includes the treatment of Dhatvagnimandya. In pathogenesis of Sthaulya, Kledaka Kapha, Samana and Vyana Vayu, Meda (fat /lipid) and Medodhatvagni Mandyata are main responsible factors. So the proper treatment should be selected, that can effect on all these factors

Danisha Sodhi

Dr. Vikas Gupta

Rakesh Mittal

English

Journal of Ayurveda and Integrated Medical Sciences (JAIMS)

    ISSN: 2456-3110                                                      REVIEW ARTICLE Mar-Apr 2017  Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2017 | Vol. 2 | Issue 2 229  A Review of Obesity and its management in Ayurveda  Vikas Gupta,1 Danisha Sodhi,2 Rakesh Mittal.3 1,2Associate Professor, 3Post Graduate Scholar, Post Graduate Department of Kriya Sharir. Jammu Institute Of Ayurveda and Research. Jammu Tawi, Jammu and Kashmir, India.                 INTRODUCTION In modern era, Every person is very busy in his daily routine. No body have time to think for the healthy life. None of usfollow  Dinacharya and Ritucharya even after knowing the importance of it . Due to this artificial living life-style, person is suffering from various life style disorders. Sthaulya is one of them. Sthaulya    is    a    condition   where    there     will    be Address for correspondence:  Dr. Vikas Gupta Associate Professor, Post Graduate Department of Kriya Sharir, Jammu Institute Of Ayurveda and Research. Jammu Tawi, Jammu and Kashmir, India. E-mail: guptavikas3003@gmail.com  Submission Date : 24/03/2017 Accepted Date: 26/04/2017 Access this article online Quick Response Code Website: www.jaims.in  DOI: 10.21760/jaims.v2i2.7734 Atyaopchaya of Shareera associated with abnormal increase in Medodhatu.  Sthaulya is one of the most effective disease which affects someone social, physical and mental features. Acharya Charaka[1] listed eight defects underlying Sthaulya Purusha - Ayuhrasa, Javopradha, Alpa-Vyavayita, Daurbalya, Daurgandhya, Swedabadha, Ati-trisha, Ati-kshudha. The patients are looking towards Ayurveda with a great hope as other system of medicines has merely insufficient management for this. Management of obesity (Sthoulya) is becoming a challenging problem for healthcare professionals, patients and their families. According to W.H.O. Obesity is listed under the 10 top selected risks to the health disorders. LITERATURE REVIEW Sthaulya A person having pendulous appearance of Sphika (Hip), Udara (Abdomen) and Stana (Chest) due to excess deposition of Meda (Fat) along with Mamsadhatu and also having unequal an abnormal A B S T R A C T  Ayurveda is originated from the Atharvaveda and was preached by Lord Brahma. Its Prayojana is to maintain the health of healthy and to cure the diseases of diseased. In Ayurveda, Sthaulya has been described in all the literatures. Acharya Charaka has described Sthaulya Purusha mong one of the Ashta Nindita Purusha. Sthaulya is caused due to Medovriddhi which includes abnormal and excessive accumulation of Medodhatu in the body. This is caused by frequent and excessive intake of Madhur and Snigdhaahara, lack of physical and mental exercises. These all results into the increase in Kapha Dosha and  Medo Dhatu results in the Sthaulya. In modern science, Sthaulya can be compared to the obesity. Obesity is one of the metabolic disorder. WHO considers obesity as a Global epidemic and a public health problem. It is estimated that more than 300 million adults are obese and many are overweight. Sthaulya (obesity) is discouraged by the society for social as well as on the medical grounds. Three main causes have been described in modern literature viz. Dietetic, Genetic and Hormonal.  Person of every age and sex is suffering by this widely spreaded epidemic i.e. obesity. It is the major chronic disease in developing as well as in developed countries. The line of treatment includes the treatment of Dhatvagnimandya.  In pathogenesis of Sthaulya, Kledaka Kapha, Samana and Vyana Vayu, Meda (fat /lipid) and Medodhatvagni Mandyata are main responsible factors. So the proper treatment should be selected, that can effect on all these factors. Key words: Medodhatu, Obesity, Sthaulyata, Sthaulya Chikitsa. Vikas Gupta et. al. A Review of Obesity and its management in Ayurveda ISSN: 2456-3110                                                      REVIEW ARTICLE Mar-Apr 2017  Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2017 | Vol. 2 | Issue 2 230  distribution of Meda with reduced enthusiasm towards life is called Atisthula.[1] According to the modern science, Obesity is defined as increase in body weight beyond the limitation of skeletal and physical requirements as the result of excessive accumulation of body fat. Classification  Vagbhata has mentioned three types of Sthaulya i.e. Adhika, Madhyama and Hina with management point of view. 1. Hina Sthaulya: (B.M.I. 25-30 kg/m2 – Over Weight) - Mild degree of overweight, without any complication or secondary disease, with less than four undesirable symptoms and with duration of less than 1 year – can be considered as HinaSthaulya. 2. Madhyam Sthaulya: (B.M.I. 30-40 kg./m2 - Obese) - Moderate degree, with least complications without secondary disease, with less than 8 undesirable symptoms and duration of 1 to 5 years can be considered as Madhyam Sthaulya. 3. Adhika Sthaulya: (B.M.I. > 40 kg./m2 – Very Obese) - Excessive degree, with complication and secondary disease with all 8 undesirable symptoms and duration of more than 5 years can be considered as Adhika Sthaulya.[3] Nidana (Etiological factors)  All the etiological factors can be classified into four groups: ▪ Atisampuranat: Excessive and uncontrolled diet habbits. ▪ Avyayamat: Less physical activities. ▪ Manasaja: Psychological factors. ▪ Beejadoshaja: Genetic / Hereditary defect.  Role of Aharatmaka Nidana Ahararasa plays an important role  in increasing  Medadhatu in Sthaulya. Acharya Sushruta has mentioned that  Sthaulya and Karshya depends upon the quality and quantity of Ahararasa.[2] All the Aharatmaka Nidana ultimately decreases physical activity, which increases Kapha and leads to Meda deposition.  Role of Viharatmaka Nidana Viharatmaka Nindana like Divaswapna having Abhishyandi property leads to blockage of the micro channels of the body, specifically in Medovahasrotas. During sleep, metabolic rate is reduced. Role of Manas Vyapara Sthaulya is also considered under the group of psychosomatic diseases Acharya Charaka, mentioned two psychological factors: Harshantya (Excessive pleasure) and Achintana (Jolliness).[1] With this type of psychological well being and jolliness that person indulges more in worldly pleasure and leads to the accumulation of excess fat.  Role of Beejadosha Acharya Charaka has described that Beejadosha plays a major role in  Medovriddhi. Defect of Beejabhagavayava i.e. part of Beeja, which resembles with Genes, may lead to defective development of that organ.[1] Bhavamishra also mentioned that increased proportionate of Meda and decreased proportion of Shukra in Beeja at the time of conception predisposes towards development of fleshy but weak body. This indicates role of hereditary factor in genesis of Sthaulya.  Samprapti (Pathogenesis) Few components of body is required for manifestation of any diseases are as follows,  1. Dosha 2. Dushya 3. Srotas 4. Agni 5. Ama 1. Dosha In pathogenesis of Sthaulya, all three Doshas are vitiated. Vikas Gupta et. al. A Review of Obesity and its management in Ayurveda ISSN: 2456-3110                                                      REVIEW ARTICLE Mar-Apr 2017  Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2017 | Vol. 2 | Issue 2 231  a) Vata: In this disease, Vata has been mentioned in the state of Avrita in Kostha, which makes the Agnivaishamya, ultimately increases the  demand of food. The  involvement of Samana Vayu[1] can be clearly postulated with the evidence of Agni Sandhukshana and improper distribution of fat in the body proves the involvement of Vyana Vayu. b) Pitta: In Pitta Vriddhi as well as in Sthaulya, the symptoms like Atikshudha, Atipipasa, Swedadhikya, Daurgandhya[2] have also been mentioned. Pachaka Pitta is mainly involved in the aetiopathogenesis of the disease.  c) Kapha: In the  pathogenesis of Kaphadosha, excessive consumption of Ahara like Guru, Snigdha, Madhura, Sheeta, Picchila; Vihara like Avyayama, Divaswapna etc. Most of symptoms of Sthaulya come under the category of Kapha Vriddhi (Prakopa).[1] i.e. Alasya, Gatrasadana, Angagaurava, Nidradhikya etc. The Sthaulya Rogi usually belongs to Kapha Prakriti so they may have slow and lethargic physical activity with Sthula Anga by nature and also they have more pleasure and less tension - anxiety, so Kapha Prakriti persons are more prone to become obese (Sthula).   2. Dushya Acharya Sushruta[2] has mentioned Sthaulya as a Dusya dominant disease and in this disease the excessive production of abnormal Meda Dhatu is clearly visualized. Kapha is seated in Meda along with other Dhatus. In  Sthaulya excessive intake of Guru Snigdha, Madhuradi Guna dominant diet, increase accumulation of Medodhatu.[2]  3. Srotasa In the Sthoulya, involvement of Medovaha Srotasa is the main factor along with the involvement of other Srotasa. According to Acharya Charaka,[1] Avyayama, Divaswapa excessive intake of Madhura Dravyas and Varuni, are the Nidana of Medovahastrotodushti.[1] It indicates clear involvement of Medovahasrotasa along with Rasavahasrotasa. Atisweda and Daurgandhya indicate the involvement of Swedavahasrotasa. Presence of Atipipasa indicates the involvement of Udakavahasrotasa. In the pathogenesis of Sthaulya, increase fat deposition inside the muscle (Vasa) indicates the involvement of Mamsavahasrotasa.   4. Agni and Ama: According to Vagbhata,[3] Mandagni is considered as root cause of all disease. Due to Mandagni, formation of Ama occurs. Sthaulya results from derangement of Dhatvagni. In Sthaulya, due to vitiation of Vata by obstruction of Meda, Tikshnagni is a prominent feature. Chakrapani and Dalhana gives explanation, that in the stage of Tikshnagni, person go for Adhyashana, Kalavyatitaaharasevana again and again, which leads to disturbance in Agni and subsequently formation of Ama may take place. It has been further explained by Dalhana that in the Sthaulya, formation of Ama is more due to decrease of Medodhatvagni than Jatharagni.  According to ‘Dhatu Parinama concept’, (at Dhatvagni level) Vriddhi of previous Dhatu and Kshaya of further Dhatu take place. In cases of Sthaulya, excessive consumption of Guru, Madhura, Snigdhaguna dominant diet produces excessive and inferiority Medodhatu Poshaka Annarasa, this makes Medodhatvagnimandya. So as per above concept in the state of Medodhatvagnimandyata, previous i.e. Medodhatu increase and further/Uttaradhatu i.e. Asthi, Majja, Shukra are decreased. According to Ayurveda: There are 7 basic tissue elements in the human body Known as Dhatus. These are present in every human body in a particular proportion and any change in the equilibrium leads to diseases. Fat or the Meda is one of the Dhatus. According to modern: Obesity can be assessed by following tools: ▪ Body Mass Index ▪ Waist circumference ▪ Waist / Hip ratio ▪ Relative Weight (Rw)                                                                       ▪ Skin fold thickness  Vikas Gupta et. al. A Review of Obesity and its management in Ayurveda ISSN: 2456-3110                                                      REVIEW ARTICLE Mar-Apr 2017  Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2017 | Vol. 2 | Issue 2 232  Body Mass Index The B.M.I. is the actual body weight divided by the height squared (kg/m2). This index provides a satisfactory measure of obesity in people who are not hypertrophied athletes.  The classification of obesity is:[5]                                                          Signs and Symptoms ▪ Reduction of longevity ▪ Unpleasant of body odour ▪ Excessive sweating ▪ Breathlessness on exertion ▪ Difficulty in walking ▪ Tiredness ▪ General deability ▪ Loss of vitality ▪ Excessive hunger Chikitsa of Sthaulya Depending on the body type, the chikitsa varies.[3] If the person is diagnosed as Vaata type, then purification procedures for Vaata like cleansing enemas. After that mild oil application and fomentation is used. Only minimum oil application is used for treating obesity. External oil application is carried out with oil containing hot herbs like calamus, ginger and mustard. External fomentation can be done by various methods like whole body fomentation via. steam box. After fomentation oil enemas will be given. Later, usually contains a decoction of Dashmoola, Honey, Salt, some specific herbs and water.[3] If the person is diagnosed as Kapha type, then external message with powders of agaru, calamus, ginger or mustard will be done.[3] These substances help to remove excess fat deposited under the skin. In obese persons, the digestive fire may be optimum.To improve its power herbs like Trikatu, Shilajit, Katuki, Barberry, Calamus, Chitraka, Karanja, Haridra, Guggulu, Arjuna, Neem, Apaamarga, Brahmi, Bilwa are used. In Ayurvedic texts different Shodhna procedure i.e. Vamana, Virechana, Lekhana Basti, Raktamokshana are mentioned for the treatment of Sthaulya. Lekhana Vasti with Varaadikwath produced statistically significant improvement in obesity. Lekhana Vasti with Varaadi Kwatha’ by virtue of its ingredients Katu, Tikta, Kashaya rasa, Laghu, Ruksha, Tikshna Guna, Ushna virya, Katuvipaka, Lekhana, Kapha-vatahara, Deepana-pachana and Sroto-shodhaka properties. Shamana Chikitsa can be implemented through seven different ways. Deepana, Marutsevana, Kshudha Nigraha, Pachana, Atapasevana, Trusha Nigraha, Vyayama. Langhana is advisable in Samtarpanajanya Vyadhi, in Amashyotha Vikara, in Shleshmika Vikara, in Rasaja Vikara. So, all seven types of Langhana can be applied for the patients of Sthaulya according to Rogi Roga Bala.  Nidana Parivarjana is also important measure for Sthaulya. Ayurveda is an alternative natural herbal treatment to cure overweight condition by balancing the body. The medicine for weight reduction is; ▪ Guduchi helps in the proper canalization of fats in the body thus used as effective ayurvedic treatment for fat reduction. ▪ Guggulu reduces fat accumulation in the body and gives a leaner physique. ▪ Indian Gooseberry contains vitamin C that disintegrates fatty buildup in the body . ▪ Under weight  -  <18.5 kg/m2  ▪ Normal weight  -  18.5 - 24.9 kg/m2  ▪ Over weight  -  25 - 29.9 kg/m2  ▪ Obesity (Class-I) -  30 - 34.9 kg/m2  ▪ Obesity (Class-II)  -  35 - 39.9 kg/m2  ▪ Morbid Obesity (Class-III)  -  > 40 kg/m2  Vikas Gupta et. al. A Review of Obesity and its management in Ayurveda ISSN: 2456-3110                                                      REVIEW ARTICLE Mar-Apr 2017  Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2017 | Vol. 2 | Issue 2 233  ▪ Use of Devadaru, Musta, Triphala, Takrarishta and honey is recommended as a natural herb cure for overweight. ▪ Powder of Yava and Amalaki is an excellent formulation for reducing fat in the body. Table 1: Diet Chart Time Contents  At 10 AM Salad vegetable/ Fruit / Puffed Rice At 11 AM Soup/ Yush/ Saktu At 12:30 PM Lunch Roti- barley(yava)/ Bajra/ Jwari/ Ragi Vegetable Chutney Butter Milk  Pickle, Amla/kumara (Aloevera)/ Bittergourd(Karvelak) At 4 PM  Snacks- Puffed rice, murmura, puffed rajgira, puffed jowar  At 7 PM Dinner - Krushara, daliya Table 2: Vegetables Name Rasa Veerya Vipaka Guna Doshaghnta Rogaghnta Bottol Guard Katu, Tikta Ushna Madhur Laghu Snigdha Tridoshghan Deepan, Pachan, Ruchya. Ridge Guard  Tikta Ushna  Katu  Laghu Ruksha, Tikshna Kapha- Pittahara  Deepna, Vamaka Gre Madh - - Laghu Kapha- Medogen Gram ur, Kashaya Vishad Pittahara hna, Jwaroghna Carrot  Madhur, Katu, Tikta Ushna  Katu  Laghu Tikshana  Kapha- Vatahara Rukshya, Deepnana  Table 3: Sthoulyahara Capsules and Medicated Water Dravya Rasa Veerya Vipaka Guna Doshghanta Rogaghnta Amalaki Panch-Rasa  Sheeta Madhur Guru, Ruksha, Sheeta Tridoshaghna Rasayana, Jwaraghna, Pramehaghna Haritaki Pancha- Rasa Ushna Madhur Laghu, Ruksha Tidoshaghna Rasayana, Jwaraghna, Kushtaghna Bibhitaka Kashaya Ushna Madhur Laghu, Ruksha Tidoshaghna Jwaraghna, Raktastambhaka Chitraka Katu Ushna Katu Laghu, Ruksha, Tikshna Kapha-Vata Shamaka Jwaraaghna, Shothahara, Kanthya Haridra Tikta, Katu Ushna Katu Laghu, Ruksha Kapha –Vata Shamaka, Pittavardhaka Kushthaghna, Vishaghna Katu Jeeraka Katu Ushna Katu Laghu, Ruksha Kapha- Vatashamaka, PittavardDeepana, Pachana, Pramehaghna Vikas Gupta et. al. A Review of Obesity and its management in Ayurveda ISSN: 2456-3110                                                      REVIEW ARTICLE Mar-Apr 2017  Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2017 | Vol. 2 | Issue 2 234  haka Methika  Katu Ushna Katu Laghu, Snigdha Vatashamaka Deepana, Pachana, Anulomana Usheera Madhur, Tikta Sheeta Katu Ruksha, Laghu Pittashamaka Trishna Nigrahana, Stambhana CONCLUSION As various methods are described above, therefore these methods are very helpful to reduce fats and to overcome the problem of obesity. Although the body nature of everyone is different from each other so the effects of the treatment may vary from individual to individual. The Ahara and Vihara also has direct effect on the treatment. Therefore, the result also vary on account of Ahara and Vihara of the person. So the person have to adopt above method strictly to get better results.    REFERENCES 1. Agnivesa, Charaka Samhita with Ayurveda Dipika Commentary, Ed.  Acharya Y.T, Chowkhamba Sanskrit Sansthan, Varanasi 1984 (Reprint). 2. Susruta, Susruta Samhita with Nibandha Sangraha and Naya Chandrikapanjika commentaries Ed. Vd. Y.T Acharya , Chaukamba Orientalia Varanasi. 3. Sarvanga Sundara on Vagbhat , Ashtanga Hridayam with Sarvanga Sundara and Ayurveda Rasayana Commentary , Ed. Kunte, AM, Chaukhamba Orientalia, Varanasi, 9th Ed. 2002 4. Dravyaguna Vijnana. vol.2, Prof. P.V. Sharma. Chaukhamba Orientalia, Varanasi 5. Association for the Study of Obesity (NAASO). The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. NIH Publication Number 00 – 4084. Rockville, MD: National Institutes of Health; 2000.       ******************************** How to cite this article: Vikas Gupta, Danisha Sodhi, Rakesh Mittal. A Review of Obesity and its management in Ayurveda. J Ayurveda Integr Med Sci 2017;2:229-234. http://dx.doi.org/10.21760/jaims.v2i2.7734  Source of Support: Nil, Conflict of Interest: None declared. 

A Review of Obesity and its management in Ayurveda

https://www.jaims.in/jaims/article/download/173/175

A Review of Obesity and its management in Ayurveda

Abstract

Similar works

Full text

Available Versions

Journal of Ayurveda and Integrated Medical Sciences (JAIMS)